+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Radical hysterectomy followed by tailored postoperative therapy in the treatment of stage IB2 cervical cancer: feasibility and indications for adjuvant therapy

Radical hysterectomy followed by tailored postoperative therapy in the treatment of stage IB2 cervical cancer: feasibility and indications for adjuvant therapy

Gynecologic Oncology 94(1): 61-66

To determine the outcome, complications and likelihood of requiring adjuvant therapy of patients with stage IB2 cervical cancer treated with primary radical hysterectomy and lymph node dissection. Clinical and pathologic data between 1985 and 1999 were reviewed. Associations between clinical and pathologic variables were tested using the Fisher's exact test. Survival was estimated using the Kaplan-Meier method with significance being calculated using the Log Rank test. Six hundred radical hysterectomies were performed during the study period. Fifty-eight of these women (9.6% of all radical hysterectomies) were diagnosed with FIGO stage IB2 cancers. Sixteen patients (28%) had positive pelvic lymph nodes. Forty-six patients (79%) had invasion involving the outer 1/3 of the cervical stroma, six had positive vaginal margins while five had occult parametrial extension. After retrospective review of the histopathologic data from this case series, criteria from two recently published prospective multicenter Gynecologic Oncology Group (GOG) trials were applied to this data set. According to criteria established by GOG protocol 92, 30 (52%) patients should have theoretically received adjuvant pelvic radiation while 21 (36%) would have qualified for adjuvant chemotherapy and radiation according to the results of GOG protocol 109. In actual fact, only 35 patients (60%) received adjuvant radiotherapy and one received adjuvant chemo-radiation. Severe toxicity was unusual with two developing urinary fistulae and one having a pulmonary embolism. Despite the lack of adjuvant therapy in most cases, only 21 women (38%) recurred of whom 11 failed on the pelvic wall, with an estimated 5-year survival of 62.1%. Radical hysterectomy and tailored adjuvant radiation therapy in stage IB2 cervical cancer is feasible. Even without the liberal use of adjuvant therapy, survival in this high-risk group compares favorably to primary chemotherapy and radiation. According to recently published randomized clinical trials, most patients should receive adjuvant postoperative therapy. The benefits of this multimodality approach require randomized study.

(PDF emailed within 0-6 h: $19.90)

Accession: 012479389

Download citation: RISBibTeXText

PMID: 15262120

DOI: 10.1016/j.ygyno.2004.04.016

Related references

Radical Hysterectomy Followed by Tailored Postoperative Therapy in the Treatment of Stage Ib2 Cervical Cancer: Feasibility and Indications for Adjuvant Therapy. Obstetrical & Gynecological Survey 59(11): 766-767, 2004

Radical hysterectomy and tailored postoperative radiation therapy in the management of bulky stage 1B cervical cancer. Cancer 63(11): 2220-2223, 1989

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer. Journal of Gynecologic Oncology 23(4): 226-234, 2012

Treatment patterns of FIGO Stage IB2 cervical cancer: a single-institution experience of radical hysterectomy with individualized postoperative therapy and definitive radiation therapy. Gynecologic Oncology 111(2): 265-270, 2008

A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy. Obstetrics and Gynecology Science 60(6): 549-557, 2017

Adjuvant postoperative radiation therapy following radical hysterectomy in stage IB CA of the cervix--analysis of treatment failure. International Journal of Radiation Oncology, Biology, Physics 14(3): 445-449, 1988

Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer. Gynecologic Oncology 32(3): 292-296, 1989

The role of adjuvant radiation therapy for patients with microscopic positive pelvic lymph nodes following radical hysterectomy for stage Ib cervical cancer. Gynecologic Oncology 52(1): 144-145, 1994

Impact of time interval between radical hysterectomy with pelvic node dissection and initial adjuvant therapy on oncological outcomes of early stage cervical cancer. Journal of Gynecologic Oncology 28(4): E42, 2018

Weekly cisplatin therapy compared with triweekly combination chemotherapy as concurrent adjuvant chemoradiation therapy after radical hysterectomy for cervical cancer. International Journal of Gynecological Cancer 21(1): 128-136, 2011

Clinical Role of Adjuvant Chemotherapy after Radical Hysterectomy for FIGO Stage IB-IIA Cervical Cancer: Comparison with Adjuvant RT/CCRT Using Inverse-Probability-of-Treatment Weighting. Plos One 10(7): E0132298, 2016

Dose-volume histogram predictors of chronic gastrointestinal complications after radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy for early-stage cervical cancer. International Journal of Radiation Oncology, Biology, Physics 85(3): 728-734, 2013

Treatment results of adjuvant pelvic radiotherapy after radical hysterectomy for low-risk Stage IB1-IIA cervical cancer. Japanese Journal of Clinical Oncology 47(11): 1024-1030, 2017

Implications of a failed prospective trial of adjuvant therapy after radical hysterectomy for stage Ib-IIa cervical carcinoma with pelvic node metastases. Changgeng Yi Xue Za Zhi 21(3): 291-299, 1998

Phase 3 Randomized Trial of Comparing Chemoradiation Therapy Versus Radiation Therapy Alone in Lymph NodeNegative Patients With Early-Stage Cervical Cancer Following Radical Hysterectomy. International Journal of Radiation Oncology*biology*physics 96(2): S11-S12, 2016