A limited role for adjuvant radiotherapy after the Wertheim/Okabayashi radical hysterectomy for cervical cancer confined to the cervix

Background. The indications for radiotherapy after radical hysterectomy for early stage cervical cancer are changing. In the past only tumor outside t he cervix was considered an indication for radiotherapy. Today adjuvant rad iotherapy is also considered for an "intermediate-risk'' group with tumor c onfined to the cervix but poor prognostic primary tumor parameters such as large tumor diameter, vascular space invasion, and deep stromal penetration . Objective. The aims of this study were to determine the risk of isolated pe lvic recurrences in an intermediate-risk group (GOG Study No. 92) and to an alyze whether this group will theoretically benefit from adjuvant pelvic ra diotherapy. Patients and methods. A retrospective analysis was performed on 271 patient s with early cervical cancer treated by a radical hysterectomy in a uniform fashion in one institute. Radiotherapy was administered only when tumor wa s found outside the cervix. Tumor diameter, capillary lymphatic space invas ion, and depth of stromal penetration were assessed in all patients. Recurr ence pattern, disease-specific survival, and recurrence-free interval were determined in the intermediate-risk group and compared with the remaining p atients of the group with tumor confined to the cervix. Results. A significant difference in disease-specific survival (89% versus 97%, P < 0.03) and 5-year recurrence-free interval (86% versus 95%, P < 0.0 2) was noted in the intermediate-risk group (n = 56) compared with the tota l group with tumor confined to the cervix. Three patients in the intermedia te-risk group died of disease with a pelvic recurrence. Two of these patien ts had a combined pelvic and distant recurrence. Conclusion. Our retrospective results fail to support a survival benefit of extending indications for adjuvant radiotherapy other than postive nodes, parametrial extension, and positive margins. (C) 1999 Academic Press.