Radiat Oncol J.  2015 Jun;33(2):109-116. 10.3857/roj.2015.33.2.109.

Prognostic analysis of uterine cervical cancer treated with postoperative radiotherapy: importance of positive or close parametrial resection margin

• Kim YJ
• Lee KJ
• Park KR
• Kim J
• Jung W
• Lee R
• Kim SC
• Moon HS
• Ju W
• Kim YH
• Lee J

• KMID: 2138880
• DOI: http://doi.org/10.3857/roj.2015.33.2.109

Abstract

PURPOSE
To analyze prognostic factors for locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) in cervical cancer patients who underwent radical hysterectomy followed by postoperative radiotherapy (PORT) in a single institute.
MATERIALS AND METHODS
Clinicopathologic data of 135 patients with clinical stage IA2 to IIA2 cervical cancer treated with PORT from 2001 to 2012 were reviewed, retrospectively. Postoperative parametrial resection margin (PRM) and vaginal resection margin (VRM) were investigated separately. The median treatment dosage of external beam radiotherapy (EBRT) to the whole pelvis was 50.4 Gy in 1.8 Gy/fraction. High-dose-rate vaginal brachytherapy after EBRT was given to patients with positive or close VRMs. Concurrent platinum-based chemoradiotherapy (CCRT) was administered to 73 patients with positive resection margin, lymph node (LN) metastasis, or direct extension of parametrium. Kaplan-Meier method and log-rank test were used for analyzing LRR, DM, and OS; Cox regression was applied to analyze prognostic factors.
RESULTS
The 5-year disease-free survival was 79% and 5-year OS was 91%. In univariate analysis, positive or close PRM, LN metastasis, direct extension of parametrium, lymphovascular invasion, histology of adenocarcinoma, and chemotherapy were related with more DM and poor OS. In multivariate analysis, PRM and LN metastasis remained independent prognostic factors for OS.
CONCLUSION
PORT after radical hysterectomy in uterine cervical cancer showed excellent OS in this study. Positive or close PRM after radical hysterectomy in uterine cervical cancer correlates with poor prognosis even with CCRT. Therefore, additional treatments to improve local control such as radiation boosting need to be considered.

Keyword

Parametrial resection margin; Uterine cervical neoplasms; Postoperative adjuvant radiotherapy

MeSH Terms

Adenocarcinoma
Brachytherapy
Chemoradiotherapy
Disease-Free Survival
Drug Therapy
Humans
Hysterectomy
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Pelvis
Prognosis
Radiotherapy*
Recurrence
Retrospective Studies
Uterine Cervical Neoplasms*