Complications of irradiation and radical surgery for gynecologic malignancies

Radical hysterectomy after full-dose pelvic irradiation is associated with a high fistula rate, high operative mortality, and decreased survival rate compared with primary radical hysterectomy. Radical hysterectomy is not recommended after full-dose pelvic irradiation. Extended radical hysterectomy after full-dose pelvic irradiation is associated with a higher complication rate than radical hysterectomy or exenteration and it should be abandoned. Preoperative reduced-dose pelvic irradiation followed by radical hysterectomy for early cervical cancer provides similar survival rates but increased complication rates compared with radical hysterectomy alone and it is not recommended. Intracavitary radium or cesium alone has not resulted in a higher complication rate, but in our experience the benefits are doubtful because the local control provided by radical hysterectomy alone was 97.4 per cent (24). The addition of pelvic irradiation after radical hysterectomy does not seem to result in significant deleterious effects on bladder function compared with either treatment modality alone. However, it is associated with increased overall, urinary, and gastrointestinal morbidity and a higher reoperation rate. In radical hysterectomy patients with positive pelvic nodes, postoperative pelvic irradiation provides improved local control but not increased survival rate. Other forms of therapy must be investigated. External irradiation to the aortic area after aortic lymphadenectomy is associated with a decreased complication rate when the external beam dose is limited to 45 Gy and lymphadenectomy is performed extraperitoneally. However, the survival benefit for patients with positive aortic nodes is minimal.