STAGE IB AND IIA CERVICAL-CANCER WITH NEGATIVE LYMPH-NODES - THE ROLEOF ADJUVANT RADIOTHERAPY AFTER RADICAL HYSTERECTOMY

The records of 171 patients with lymph node-negative stage IB and IIA cervical cancer primarily treated with radical hysterectomy and pelvic lymphadenectomy from 1974 to 1992 were retrospectively reviewed to id entify poor prognostic factors and evaluate the role of adjuvant pelvi c radiotherapy. One hundred sixteen patients (68%) were treated with r adical hysterectomy alone (RH) and 55 patients (32%) received adjuvant radiotherapy (RH + RT). Factors predictive of recurrence for the enti re group of patients included lymph-vascular space invasion (LVSI) (P = 0.003) and grade 3 histology (P = 0.04). Patients receiving RH + RT were older and more likely to have outer third cervical wall invasion, LVSI, positive margins, greater than or equal to 2 cm pathologic tumo r size, and > 4 cm clinical tumor size (all P < 0.05). Overall, 28 pat ients (16%) developed recurrent disease with no difference between RH and RH + RT groups. After controlling for confounding variables, patie nts with LVSI who received RH + RT were less likely to develop disease recurrence than patients receiving RH alone (P = 0.04). LVSI is an im portant prognostic variable in lymph node-negative stage IB and IIA ce rvical cancer. Although adjuvant pelvic radiotherapy may decrease the risk of recurrence in patients with LVSI, the majority of patients wit h negative lymph nodes may be treated with radical surgery alone. (C) 1997 Academic Press.