Radical Hysterectomy Followed by Tailored Postoperative Therapy in the Treatment of Stage IB2 Cervical Cancer: Feasibility and Indications for Adjuvant Therapy

Abstract

The authors reviewed the medical records of their institutions and identified 600 women who underwent radical hysterectomy and lymph node dissection for treatment of invasive cervical carcinoma between 1985 and 1999. Fifty-eight of these patients could be classified as FIGO stage IB2 and served as subjects for an analysis of the use of postoperative therapy after radical hysterectomy in patients with stage IB2 cervical cancer. The average age at diagnosis was 43.4 years. Almost three fourths (n = 36, 72%) had squamous cell tumors of which 22 were nonkeratinizing and 14 were keratinizing squamous cell cervical cancer. The remaining 28% had adeno- (n = 7) or adenosquamous (n = 5) carcinoma. Overall mean tumor size was 5.2 cm. Positive pelvic lymph nodes were seen in 16 patients (16 of 55, 28%). Thirty-seven (63.7%) had lymphvascular space invasion, and 46 (79.3%) had cervical stromal invasion greater than one third. Vaginal margins were positive in 6 women (10.3%) and f5 had parametrial extension. Thirty-five of the 58 women (60%) were treated with adjuvant radiation therapy. Twenty-one received both teletherapy and brachytherapy, and 1 patient was also given chemotherapy. Risk factors among the 35 patients who had adjuvant radiation included positive pelvic nodes, positive vaginal margins, and positive parametrial margins. Two patients developed vesicovaginal fistulas and 1 had a pulmonary embolism. Two women required more than 4 units of blood. No patient died as a result of treatment. Positive pelvic lymph nodes were a significant predictor of complication (P = 0.01). Fifty-five of the 58 study patients had complete follow-up information. Of the remaining 55, 21 (38%) developed a recurrence of disease, 11 in the pelvic wall. Other sites included 2 central, 2 paraaortic node, 2 vaginal or bladder, 3 lung, and 1 upper abdomen recurrence. Median time to recurrence was 15.6 months (range, 2–47 months). After a mean follow up of 77.6 months, no patients were dead of disease. Two were alive with disease and 2 died of other causes. The estimated 5-year survival is 62.1%.