RADIATION-THERAPY RESULTS FOR PATIENTS UNDERGOING INAPPROPRIATE SURGERY IN THE PRESENCE OF INVASIVE CERVICAL-CARCINOMA

Total vaginal or abdominal hysterectomy was considered an inadequate t reatment method for invasive uterine cervix cancer. Usually the proced ure was inadvertently performed on patients who were thought preoperat ively to have benign or premalignant conditions. Between 1985 and 1993 , 64 patients undergoing hysterectomy in the presence of invasive cerv ical cancer were treated with external radiation therapy and/or intrac avitary radiotherapy. Preoperative diagnoses were carcinoma in situ (3 6), severe dysplasia (2), and early invasive cancer (14), and others w ere benign disease. Overall 5-year survival and relapse-free survival rates were 75.8 and 77.5%, respectively. For patients in retrospective stage IA, IB, and IIB (gross residual after surgery), overall 5-year survival rates were 90.9, 88.8, and 27.9%, respectively. Thirteen pati ents developed treatment failure; most of them (10/13) were patients w ith gross residual disease. Patients with early invasive cervical canc er (stage IA) had no treatment-related failure. Prognostic factors aff ecting survival by univariate analysis were retrospective stage (P = 0 .0000) and preoperative diagnosis (P = 0.0021). Tumor histology was ma rginally significant factor (P = 0.0938). By multivariate analysis, on ly retrospective stage was significant prognostic factor (P = 0.0001). Adjuvant radiotherapy appears to be an effective treatment method for patients with presumed stage IA and IB after inadvertent hysterectomy . Survival for patients with gross disease remaining after inappropria te hysterectomy is poor. So, early cancer detection and proper managem ent with precise pretreatment staging is necessary to avoid inadherent hysterectomy, especially in cases of gross residual disease. (C) 1997 Academic Press.