Analysis of failures in patients with cervical carcinoma treated by radical surgery and external pelvic irradiation

In this paper we examine 68 patients who had undergone radical abdominal hysterectomy according to Wertheim-Meigs for Ib-II cervical carcinoma. Post-surgical stage was T1bN0M0 in 35 patients, T1bN1M0 in 3, T2aN0M0 in 7, T2aN1M0 in 6, T2bN0M0 in 13, T2bN1M0 in 4. All the patients, except 5 with ureteral fistulas, had high energy external pelvic irradiation, reaching a dose of 45 Gy. Up to December 1986, the neoplasia had relapsed in 10 patient (14.7%). According to post-surgical stage we observed 1/38 relapses in T1b patients (2.63%), and 9/30 relapses in T2 ones (30%). Otherwise, we observed 3 relapses in the 55 patients with negative lymph-nodes (5.4%), and 7 recurrences in the 13 patients with histologically proven positive lymph-nodes (53.8%). In these last patients 3/7 relapses were distant (42.8%). Nodes status seems to be the most important prognostic factor in patients with IB-II cervical carcinoma. Since lymph-nodal involvement could be indicative of a systemic spreading of disease, we think that an adjuvant polychemotherapy, in addition to surgery and radiotherapy, could improve the prognosis of patients with positive lymph-nodes.