The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy

Purpose. This study was undertaken to evaluate the efficacy of postoperativ e radiotherapy (post-OP RT) and to investigate the prognostic factors for e arly-stage cervical cancer patients who were treated by radical surgery, an d the pathological findings suggested a relatively high risk of relapse wit h surgery alone. Materials and methods. From January 1990 to December 1995, 222 patients wit h stage IB-IIA cervical cancer, treated by radical surgery and a full cours e of post-OF RT, were included in this study. The indications for post-OF R T were based on pathological findings, including lymph node metastasis, pos itive surgical margins, parametrial extension, lymphovascular permeation, a nd invasion of more than two-thirds of the cervical wall thickness. The rad iation dose of external beam was 44-45 Gy to the whole pelvis and 50-54 Gy to the true pelvis. One hundred seventy-two patients also received intravag inal brachytherapy as a local boost. The minimal follow-up period was 2 yea rs. Results. The actuarial 5-year overall and disease-specific survival rates f or all patients were 76 and 82%, respectively. The tumor control rate withi n the pelvis reached 94%, and distant metastasis was the major cause of tre atment failure. Univariate analysis of clinical and pathological parameters revealed that clinical stage, bulky tumor size, positive lymph nodes, para metrial extension, and histologic type were significant prognostic factors. After multivariate analysis, only positive lymph nodes (P = 0.01), bulky t umor size (P = 0.02), and parametrial extension (P = 0.05) independently in fluenced the disease-specific survival (DSS). For patients with lymph node metastasis, the number and location of the nodal involvement significantly affected the prognosis. The 5-year DSS for patients with no, one, and more than one lymph node metastasis were 87, 84, and 61% (P = 0.0001), respectiv ely. Patients with upper pelvic lymph node metastasis had a higher incidenc e of distant metastasis (50% vs 16% in lower pelvic node group, P = 0.03). Ln the subgroup of single lower pelvic nodal metastasis, the prognosis was similar to that of patients without lymph node involvement (5-year DSS 85% vs 87%, P = 0.71). Conclusion. Our results indicate that post-OP RT can achieve very good loca l control in stage IB-IIA cervical cancer patients whose pathological findi ngs show risk features for relapse after radical surgery. The prognostic fa ctors for treatment failure identified in this study can be used as selecti on criteria for clinical trials to test the effects of other adjuvant treat ments, such as chemotherapy. Patients with a single lower pelvic lymph node metastasis have a relatively good prognosis and may not need adjuvant trea tment beyond radiation therapy, (C) 1999 Academic Press.