[A risk score for surgically treated stage Ib cervix carcinoma and its significance for postoperative irradiation]

The value of adjuvant irradiation in stage Ib cervical cancer is not clear. In a retrospective study of 171 cases of stage Ib cervical cancer tumor grading, tumor size, blood and lymphatic vessel invasion and pelvic lymph node metastases were analysed. A simple score of these risk factors is proposed enabling assignment into patient groups of similar risk on the basis of a points system for individual prognostic factors. 90 patients were treated by radical surgery alone, 81 patients received adjuvant pelvic irradiation (56 Gy). 5-year survival after surgery alone was 95.6%, in comparison with only 79% after adjuvant irradiation (p less than 0.001). However, when patients with a similar risk score are compared, the outcome of adjuvant irradiation was found to be favourable. With a score of 6 to 10 points 5-year survival after surgery alone was 75%, whilst with adjuvant irradiation the rate rose to 92%. In this risk group relapses were observed after surgery alone in 37%, whilst with adjuvant irradiation only 4% relapsed. 20 of 21 deceased patients had a risk score of 6 and more points. The incidence of risk factors in the group treated by surgery alone was significantly lower than in the group with adjuvant irradiation (p less than 0.0001). Therefore the unfavourable result in the group given adjuvant irradiation becomes quite clear. Adjuvant irradiation is recommended in stage Ib cervical cancer for patients with a risk score of 6 and more points. Adjuvant radiotherapy should not be hastily replaced by other modalities of adjuvant treatment.