Retrospective analysis of postoperative radiotherapy for node-negative cervical carcinoma with stage IB-IIB disease

We performed retrospective analysis to evaluate the outcomes of postoperative radiotherapy for patients with cervical carcinoma without lymph node metastasis.

From 1981 to 1995, 68 stage I-II cervical carcinoma patients without nodal disease who received adjuvant pelvic radiotherapy were entered into the present analysis. Criteria for postoperative radiotherapy were (1) deep stromal invasion (> or = 1/2; n = 63), (2) positive parametrial invasion (n = 38) and (3) close or positive surgical margin (n = 21). The median patient age was 54.0 years (range, 29-69 years). The median dose of 45.3 Gy (range, 43.4-56.4 Gy) was delivered over the whole pelvis median 21.0 days (range 12-68 days) after surgery.

The 5/10-year overall survival, disease-free survival, pelvic control and distant metastasis-free survival rates were 89.7/85.7, 85.3/83.2, 95.5/95.5 and 90.7/90.7%, respectively. Histology of adenocarcinoma (n = 4), large tumor size and prolonged period between operation and radiotherapy were significantly adverse prognostic factors of overall and disease-free survival by univariate analysis. The risk score referred from the GOG report correlated well with disease-free survival (P = 0.018), but showed only a tendency for overall survival as a prognostic factor (P = 0.07). Overall treatment time proved to be a significant variable for overall survival (P = 0.02), but not for disease-free survival (P = 0.056). Both risk score and overall treatment time proved to be significant prognostic factors in the multivariate model. Major adverse effects occurred in three patients (4.4%) without mortality.

In this analysis, clinical outcome from adjuvant postoperative radiotherapy was thought to be feasible with both satisfactory pelvic control and acceptable lower toxicity.