Objective. The aim of this study was to evaluate the frequency with which i
ntended radical hysterectomy for cervical cancer is abandoned and the outco
mes for those patients.
Methods. A secondary evaluation of a prospective surgical pathological tria
l was performed. There were 1127 patients with Stage TB carcinoma of the ce
rvix entered on Gynecologic Oncology Group Protocol No. 49. These patients
were to undergo radical hysterectomy and pelvic lymphadenectomy with carefu
l analysis of pathologic findings, complications, and outcomes.
Results. Ninety-eight women were found, at operation, to have extrauterine
disease and the proposed radical operation was abandoned at the discretion
of the operating surgeon. The records of these patients were evaluated. Sub
groups of patients with extrapelvic disease (30) and pelvic extension (26),
including grossly positive pelvic nodes (12), other pelvic implants (8), a
nd gross serosal extension (2), were identified. Sixty-three (93%) patients
subsequently underwent pelvic radiation therapy and one or two intracavita
ry applications. Para-aortic fields were added for 8 patients who were foun
d to have positive para-aortic nodes. Five patients received radiotherapy a
nd chemotherapy; 4 patients received chemotherapy alone. One patient declin
ed any further therapy. The disease-free survival was shorter for patients
whose radical procedure was abandoned than for those patients who underwent
radical hysterectomy. Among the abandoned-operation patients, those with e
xtrapelvic disease had the shortest progression-free interval and survival
and those with direct pelvic extension the longest.
Conclusions. Retrospective comparisons of radical hysterectomy to radiation
therapy are not valid unless the group of patients whose radical operation
was abandoned is included. The morbidity of the operation is low even when
followed by radiation therapy. However, no recommendations for optimal the
rapy can be made from this analysis. (C) 2000 Academic Press.