Results of radiation therapy given after radical hysterectomy

Two hundred twelve patients with carcinoma of the cervix, Stage I (193 patients) and Stage II (19 patients), were treated by radical hysterectomy at the Hospital of the University of Pennsylvania during the period from 1955-1977. Pathology reports were evaluated for the presence of the following factors thought to indicate an unfavorable prognosis: (1) positive pelvic lymph nodes (31 patients); (2) parametrial extension (22 patients); and (3) infiltration of the margin of resection (14 patients). Fifty-one high risk patients (HR) with one or more of these pathologic findings have five and ten year survivals of 55% and 30%, respectively. This compares with five- and ten-year survivals of 87% and 85%, respectively, for patients without these findings. Local recurrences were noted in 20/50 (40%) HR patients versus 23/159 (13.2%) non-HR patients (P less than .001). A retrospective analysis revealed that 21 of 50 evaluable HR patients received adjunctive postoperative pelvic irradiation (HR-XRT). Although the reduction in local recurrence in the treated group approached statistical significance, 5/21 versus 15/29 (0.1 greater than P greater than 0.05), the five- and ten-year survival did not differ significantly. Twenty-four patients initially treated with surgery received definitive radiation therapy for local recurrence. The five- and ten-year survivals for the time of recurrence were 22% and 15%. Our findings suggest that postoperative irradiation may be beneficial in controlling local disease in a subgroup of radical hysterectomy patients who are at high risk for recurrence. Since the ultimate incidence of extra pelvic metastasis for the high risk and the recurrent group is 32% and 67%, respectively, however, it appears that improved survival awaits the development of effective systemic adjuvant therapy.