Adjuvant Postoperative Radiation Therapy for Carcinoma of the Uterine Cervix

Lee, Kyung Ja; Moon, Hye Seong; Kim, Seung Cheol; Kim, Chong Il; Jung, Ja Ahn

Abstract

PURPOSE: This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelviclymph node dissection.
MATERIALS AND METHODS
Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study.The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, lymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy.All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy.The radiation dose from the external beam to the whole pelvis was 45 50 Gy.Vagina cuffirradiation was performed, after completion of the external beam irradiation, at a low-dose rate of Cs-137, with the total dose of 4488 4932 chy (median:4500 chy)at 5 mm depth from the vagina surface.The median follow-up period was 44 months (15 108 months).
RESULTS
The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95%and 94%, respectively.A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002)andparametrial extension (p=0.0001)affected the disease-free survival.From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival.Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients)and lymphedema of the leg (1 patient).No patient had grade 3 or 4 complications.
CONCLUSION
Our results indicate that postoperative radiation therapy can achieve good local control and survival rates for patients with stages IB-IIB cervical cancer, treated with a simple hysterectomy, as well as for those treated with a radical hysterectomy, and with unfavorable pathological findings.The prognostic factor for disease-free survival was invasion of the parametrium.The prognostic factor identified in this study for treatment failure can be used as a selection criterion for the combined treatment of radiation and chemotherapy.