Clinicopathological correlates and need for adjuvant radiotherapy in early stage carcinoma cervix

Abstract

Objective: To analyse clinical-pathological findings in women undergoing surgery for early stage carcinoma cervix and to determine the need for adjuvant radiotherapy. Methods: The study was a retrospective one done to analyse data of women who had been operated for carcinoma cervix in the last 10 years at a tertiary hospital in Delhi. Type II/III radical hysterectomy with pelvic lymphadenectomy was done depending on stage. Histopathological findings and need for adjuvant therapy based on presence of clinical and pathological criteria were studied. Results: A total of 93 eligible patient records were included in the study. Mean age and parity was 48.09 ± 22.36 years and 4.29 ± 3.9 respectively. 47.31% (44) of the women had stage 1B1 carcinoma cervix; 31.18% (29) had stage 1B2 and 19.35% (18) had stage 2A disease. Average size of the tumour growth was 3.25 ± 2.46 cm with the largest being 7 cm. Keratinising squamous cell carcinoma was seen in 48.38% (45) of patients whereas the non-keratinising one was seen in 33.33% (31). Large cell variant was seen in 6.45% (6) whereas micro invasive cancer was seen in 4 women. Adenocarcinoma constituted only 3.2% (3) of the study group. Vaginal cuff involvement was present in 9.67% (9) of patients and an equal number had occult parametrial invasion. A significant number of these had stage 2A disease (16.66% and 22.22% respectively). Between 1B1 and 1B2 there was no significant difference in the incidence of vaginal cuff involvement and occult parametrial invasion (P equals to 0.206 and 1 respectively). Lymph nodes were positive in 24.73% with the obturator lymph node being the commonest involved (17). In stage 1b1 25% (11) had positive lymph nodes; in stage 1B2 34.48% (10) and in 2A only one woman had positive pelvic lymph nodes. This difference was also not significant (P = 0.434). About 50% (47) of patients were referred for adjuvant radiotherapy on the basis of the pathological findings. 61% (11) of patients with stage 2A disease, 51.7% (15) of patients with stage 1b2 and 45.45% (20) with stage 1B1 disease required adjuvant radiotherapy. Conclusion: There was no significant difference in the pathological findings in patients of 1B1 and 1B2. Also the need for radiotherapy in both the groups was similar. Hence similar surgical approach to women with both 1B1 and 1B2 disease appears appropriate.