Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix stage Ib and IIa treated with preoperative irradiation and surgery

Purpose: The purpose of this analysis was to evaluate the prognostic signif icance of cervical tumor size in patients with Stages Ib and IIa carcinoma of the cervix treated with preoperative irradiation and radical or conserva tive hysterectomy. Methods and Materials: This study is a retrospective analysis of 177 patien ts. One hundred forty-one patients had Stage Ib and 36 patients had Stage I Ia carcinoma of the cervix. All patients were treated with preoperative irr adiation and surgery. Radiation therapy consisted of external pelvic irradi ation and intracavitary brachytherapy; total doses ranged from 30 to 60 Gy to the pelvic sidewall and 60 to 70 Gy to point A. Surgery consisting of ra dical hysterectomy and lymph node dissection or a conservative hysterectomy and lymph node dissection was performed 4 to 6 weeks after completion of i rradiation. Results: The 5-year progression-free survivals were 80% for Stage Ib and 63 % for Stage IIa (p = 0.03). The 5-year cumulative pelvic failure rates for Stage Ib were 16% for tumors <3 cm and 9% for tumors >3 cm (p = 0.90). The 5-year cumulative pelvic failure rates for Stage IIa were 22% for tumors <3 cm and 22% for tumors >3 cm (p = 0.75). The corresponding cumulative dista nt metastasis failure rates at 5 years for Stage Ib were 21% for tumors <3 cm and 21% for tumors >3 cm (p = 0.60). For patients with Stage IIa disease , the 5-year cumulative distant metastasis rates were 33% for tumors <3 cm and 36% for tumors >3 cm (p = 0.70). A multivariate analysis was performed to evaluate prognostic factors for the endpoint of progression-free surviva l. The variables that were analyzed were patient age, tumor histology, tumo r size, clinical stage, point A and pelvic lymph node irradiation dose, and cervical tumor status and pelvic lymph node status at the time of hysterec tomy. The variables that were found to be of independent significance for p rogression-free survival by multivariate analysis were pelvic lymph node ir radiation dose (p < 0.001), pelvic lymph node status at the time of hystere ctomy (p = 0.01), and clinical stage (p = 0.02). Cervical tumor size at the time of diagnosis and the presence of tumor cells in the cervix in the hys terectomy specimen was not an independent prognostic factor by multivariate analysis. The overall severe complication rate was 11% for all patients. Conclusions: For this population of patients treated with preoperative irra diation and surgery, pelvic lymph node status at the time of hysterectomy a nd the preoperative irradiation dose to the pelvic lymph nodes are independ ent predictors of progression-free survival and the development of distant metastasis. The pretreatment cervical tumor size is of less importance for predicting progression-free survival and the development of distant metasta sis but clinical stage is an important prognostic variable. These results a re in contrast with those of surgery or irradiation alone, in which primary tumor size is a critical prognostic factor for all outcome parameters. (C) 1999 Elsevier Science Inc.