Significant Difference In Disease-specific Survival Research Articles

Improved outcomes in patients with lymph node-only stage IV disease in clear cell sarcoma: Results from a large single-institution experience and SEER database analysis

10571 Background: Clear cell sarcoma, or malignant melanoma of soft parts, is a rare soft tissue tumor unusual among mesenchymal malignancies for its propensity to metastasize to regional lymph node basins. Current AJCC staging for soft tissue sarcoma classifies nodal disease (N1) as stage IV disease. We sought to determine whether patients with lymph node-only disease (N1M0) had better outcomes than patients with distant metastases (M1) by looking at outcomes from both a single institution and population-based data. Methods: Clinical and pathologic factors were retrospectively examined utilizing a prospectively maintained database on patients treated at the University of Texas M.D. Anderson Cancer Center (MDACC) between 1980 and 2007. Histology on all patients was independently reviewed by a single MDACC pathologist with molecular confirmation of the characteristic EWSR1-ATF1 fusion transcript or EWSR1 rearrangement when possible. We also performed a SEER database analysis on patients diagnosed with clear cell sarcoma (1988–2007). Overall and stage-specific disease-specific survival (DSS) were estimated using the methods of Kaplan and Meier. Results: Fifty-three patients with clear cell sarcoma were identified from the MDACC database. Median age at diagnosis was 41 years and 60% were female. Our SEER analysis yielded 130 patients with a median age of diagnosis of 40 years and 54% female. Median follow-up for the MDACC cohort was 7.4 years and median follow-up for SEER was 6 years. MDACC 5-year DSS was 67.9% and, in the SEER analysis, 5-year DSS was 61.9%. The 5 year DSS of N1 patients from MDACC was 74%, while M1 was 14% (p=0.0142). The 5-year DSS of N1 patients from SEER was 52%, while M1 was 0% (p=0.0142). Conclusions: Overall DSS in both our single-institution cohort and in SEER is higher than in previously published series. There is a significant difference in DSS between N1M0 and M1 patients for both MDACC and SEER cohorts. These data underscore the importance of lymph node assessment in these patients and suggest that future staging of clear cell sarcoma should differentiate these groups. No significant financial relationships to disclose.

A comparison of the survival and disease-specific survival of surgically resected, node-positive bronchioloalveolar carcinoma to that of non-small cell lung cancer: Implications for adjuvant therapy

7536 Background: Node postive presentations of Bronchioloalveolar Carcinoma are quite rare. The purpose of our investigation is to assess whether disease-specific survival (DSS) and overall survival (OS) are different for patients with N1 and N2 bronchioloalveolar carcinoma (BAC) compared to non-BAC non-small cell lung cancer (NSCLC). Methods: The Surveillance, Epidemiology, and End Results (SEER) program data-base from 1992–2002 contained 684 patients with BAC and 9809 patients with non-BAC NSCLC with N1/N2 presentations who underwent a definitive surgical procedure. Overall survival (OS) and Disease-specific survival (DSS) rates were compared according to potential prognostic factors, including use of a matched-pair analysis. Results: The BAC patients with either pathologic N1 or N2 nodal stage were significantly more likely to be of female gender, non-black/non-white Race, and significantly less likely to have poorly differentiated or undifferentiated grade than patients with non-BAC cancers of comparable nodal stages. Median follow-up of patients was 29 months. There was a significant difference in DSS between patients with N2 BAC and non-BAC cancers, but not for patients with N1disease. There was a non-significant trend for higher OS for patients with N2 BAC compared to non-BAC cancers. Conclusions: Patients with node-positive BAC have distinctly different patient and tumor characteristics than patients with node-positive non-BAC NSCLC. Because DSS appears to be better for patients with N2 BAC, they may not benefit as much from adjuvant therapy as patients with non-BAC NSCLC. Multivariate analysis of OS and DSS for N1 and N2 patients in the matched pair data set Variable P(N1-OS) P(N1-DSS) P(N2-OS) P(N2-DSS) Age 8.7E-07 0.000908 0.345176 0.455014 Grade 0.227318 0.498733 0.541656 0.050089 Nodes,# Examined 0.772861 0.76045 0.816499 0.675187 Nodes, # Positive 5.24E-05 1.26E-05 0.04167 0.290783 BAC pathology 0.857825 0.850597 0.133668 0.017227 Diagnosis after 1998 0.002815 0.007124 0.492203 0.254192 Stage 0.292619 0.083372 0.163028 0.047375 Surgery Extent 0.812828 0.295294 0.114624 0.057384 Tumor Diameter 0.105579 0.670346 0.168403 0.226083 No significant financial relationships to disclose.

A comparison of survival and disease‐specific survival in surgically resected, lymph node‐positive bronchioloalveolar carcinoma versus nonsmall cell lung cancer

The objective of this study was to assess whether disease-specific survival (DSS) and overall survival (OS) differed among patients who had N1 and N2 bronchioloalveolar carcinoma (BAC) compared with patients who had non-BAC nonsmall cell lung cancer (NSCLC). The Surveillance, Epidemiology, and End Results (SEER) Program database from 1992 to 2002 contained 684 patients with BAC and 9809 patients with non-BAC NSCLC who had N1/N2 tumors and who underwent a definitive surgical procedure. OS and DSS rates were compared according to potential prognostic factors, including the use of a matched-pair analysis. The BAC patients with either pathologic N1 or N2 lymph node status were significantly more likely to be women, and nonblack/nonwhite race, but significantly less likely to have poorly differentiated or undifferentiated tumors than patients with non-BAC cancers with comparable lymph node status. The median follow-up of all patients was 29 months. There was a significant difference in DSS between patients with N2 BAC and non-BAC cancers, but not for patients with N1 disease. There was a nonsignificant trend toward longer OS for patients with N2 BAC compared with non-BAC cancers. Patients with lymph node-positive BAC had distinctly different patient and tumor characteristics than patients with lymph node-positive non-BAC NSCLC. Because DSS appears to be better for patients with N2 BAC, they may not benefit as much from adjuvant therapy as patients with non-BAC NSCLC.

Carcinoma Metastatic to Cervical Lymph Nodes From an Occult Primary Tumor: The Outcome After Combined-Modality Therapy

The aim of this retrospective analysis was to analyze the results of treatment of patients with cervical node metastases from carcinoma of occult primary with a policy including neck dissection and postoperative comprehensive radiotherapy. Ninety patients were treated with curative intent from 1990 to 2002. The actuarial rate of neck disease control was 68.8% at 5 years (95% confidence interval [CI], 58.9%-78.7%). On multivariate analysis, the rate of neck disease control was significantly related to lymph nodal metastatic level (P = .006). The actuarial rate of developing head and neck primary tumors at 5 years was 8.9% (95% CI, 2.6%-15.2%). The 5-year actuarial rate of distant metastases was 19.1% (95% CI, 9.4%-28.9%). In multivariate analysis, a statistically significant difference in the rate of distant metastasis was obtained when patients were stratified according to the level of nodal involvement (P = .01) and the presence of extracapsular extension (P = .013). At the time of analysis, 50 of the 90 patients were alive. A total of 32 (35.6%) had died from causes related to their primary disease. Actuarial disease-specific survival at 2 and 5 years was 73.6% (95% CI, 64.3%-82.9%) and 62.8% (95% CI, 51.9%-73.7%), respectively. In multivariate analysis, a statistically significant difference in disease-specific survival was obtained when patients were stratified according to the level of nodal involvement and the presence of extracapsular extension. Our study seems to support the use of combined-modality therapy in patients with neck metastases from carcinoma of occult primary. However, in the absence of randomized trials, comprehensive irradiation cannot be routinely advised.

Prognostic Significance of Level and Number of Lymph Node Metastases in Patients with Gastric Cancer

To present data that provide some insight into the appropriateness of a nodal grouping category and its relation to survival in patients with gastric cancer. We reviewed data of 777 patients with advanced gastric cancer who had undergone curative gastrectomy to investigate the prognostic significance of level and number of lymph node metastases. The prognosis of patients with gastric cancer was well correlated with the level and number of lymph node metastases. Multivariate analysis indicated that the level and number of lymph node metastases were independent prognostic indicators. Moreover, the number of lymph node metastases was an independent prognostic factor in N1, N2, and N3 patients. The most statistically significant difference in disease-specific survival was observed at a threshold of 11 lymph node metastases, yielding a chi2 value of 42.88, a hazard ratio of 2.523, at a 95% confidence interval of 1.913, 3.329 (P < .0001) by Cox proportional hazard model. On the basis of this result, patients were divided into two groups as follows: marked lymph node metastasis group (number of positive nodes > or =11) and slight lymph node metastasis group (number of positive nodes < or =10). The prognosis of patients with marked lymph node metastasis was statistically significantly worse than that with slight lymph node metastasis in N1, N2, and N3 patients. Both level and number were indispensable for evaluating lymph node metastasis. Therefore, addition of the number of positive nodes to the N category defined by the Japanese Classification of Gastric Carcinoma may be a useful strategy in the N staging classification in gastric cancer.

Review of the M.D. Anderson experience in the treatment of bladder sarcoma

Objective To assess the histologic subtypes, clinical presentations, treatment approaches, and treatment-related outcomes of patients with bladder sarcoma. Methods Between January 1985 and July 2004, 19 patients (12 men and 7 women) with primary bladder sarcoma were evaluated at the University of Texas M.D. Anderson Cancer Center. Median follow-up duration was 72 months (range 3–141). Results The median age of patients at presentation was 57 years (range 22–94). The histologic subtypes of bladder sarcoma were leiomyosarcoma (N = 14), angiosarcoma (N = 3), and unclassified sarcoma (N = 2). The clinical presentation consisted of gross, painless hematuria in 79% of patients, lower urinary tract symptoms in 16%, and microhematuria in 5%. The primary treatment modalities used were surgery in 16 (84%) patients, chemotherapy in 2 (11%), and palliation in 1 (5%). The rate of local and distal recurrence was 16% and 53%, respectively. The most common sites of distant metastases were the lungs, bone, brain, and liver. The 5-year disease-specific survival rate was 59%, with a median survival duration of 6 years. There was no statistically significant difference in disease-specific survival between patients with bladder leiomyosarcoma compared to other sarcoma subtypes ( P = 0.149). Lymphovascular invasion ( P = 0.03) and lymphatic metastasis ( P = 0.03) were associated with disease-specific survival, and surgical margin status was associated with recurrence-free ( P = 0.04), disease-specific ( P = 0.03), and overall survival ( P = 0.005). Conclusions Bladder sarcoma is a highly aggressive malignancy, regardless of its histologic subtype. Surgical margin status is an important determinant of survival.

Immediate versus staged urethrectomy in patients at high risk of urethral recurrence: Is there a benefit to either approach?

Objectives To compare treatment-related outcomes of immediate and staged urethrectomy in patients at high risk of urethral recurrence. Methods We retrospectively identified 76 male patients with cystectomy for transitional cell carcinoma of the bladder who had undergone urethrectomy in the absence of established urethral recurrence. Concomitant cystoprostatectomy and urethrectomy was performed in 57 patients and staged urethrectomy in 19 patients. The criteria for staged urethrectomy were the presence of a positive urethral margin or established transitional cell carcinoma of the urethra in the cystectomy specimen. The mean interval from cystectomy to staged urethrectomy was 4.7 months (range 1.4 to 14). Results The most common pathologic finding of the urethrectomy specimens was prostatic duct involvement (31.6%) in the immediate urethrectomy group and Stage pT0 in the delayed urethrectomy group (73.7%). No statistically significant difference in disease-specific survival was noted between the immediate and staged groups ( P = 0.14). Similarly, no difference was noted in postoperative complication rates or total operative blood loss ( P = 0.77 and P = 0.64, respectively). However, a slight benefit for immediate urethrectomy was noted in the total duration of hospitalization ( P = 0.01). The presence of local or distant recurrence was a predictor of disease-specific survival ( P = 0.02 and P = 0.02, respectively). Conclusions Immediate and staged urethrectomy appear to be similar in surgical morbidity and disease-specific survival. A benefit was noted for the immediate group in the total duration of hospitalization. The development of local or distant recurrence was a predictor of poor survival.

A new approach in breast cancer with non-inflammatory skin involvement

The widely accepted image of breast cancer with non-inflammatory skin involvement (T4b) is determined by the tenet that all these tumors are locally advanced (Stage IIIB). The study addresses the question whether this view is justified. Data from 453 non-metastatic breast cancer patients were collected retrospectively. Eighty-one patients had T4b disease. To assess the malignant potential of tumors independent of the feature skin involvement, a reclassification only considering tumor size was undertaken. We compared the clinical course of three study groups (A: Stage II; B: Stage IIIA; C: Stage IIIC) with control groups of 372 patients without skin involvement. In the study groups, we found a broad distribution among the stages (A:36.2%; B:33.7%; and C:27.7%) with significant differences in disease-specific survival (DSS) (A/B: p = 0.032; B/C: p = 0.048). There were no significant differences in DSS between the study and the corresponding control group. In multivariate analysis, skin involvement was not a significant predictor of DSS. Heterogeneity of the T4b category and a lack of prognostic significance expand the widely accepted image of breast cancer with non-inflammatory skin involvement. The highest T category, or Stage III, is not the appropriate classification for a considerable number of patients having this clinicopathologic entity.

Using cancer registry data for survival studies: the example of the Ontario Cancer Registry

Background and Objectives The Ontario Cancer Registry (OCR) is a population-based tumor registry created to provide data for epidemiologic research and for cancer surveillance. Recently it has been used for health services research. The objective of this project was to assess the quality of the OCR data that is used in survival analysis. Methods and Design Clinical information for 898 patients with squamous carcinoma of the head and neck including index tumor site, date of diagnosis, vital status, date of death, and cause of death from a prospective database at the Kingston Regional Cancer Center is compared to the same data elements in the OCR for the same patients. Results There is no statistically significant difference in disease-specific survival between the information from the two databases (log rank P = .89). The OCR captured and correctly assigned index tumor site for 81.4% (detection rate). The site assignment was accurate 90.9% of the time (confirmation rate), there was agreement on vital status (dead vs. alive) for all but one patient, and there was excellent agreement on date of death. However, cause of death (cancer vs. noncancer) based on death certificates had a 31% error rate. Conclusion Researchers can be confident in the survival analysis generated from data in this registry, but need to be aware of potential sources of error.

Breast carcinoma with noninflammatory skin involvement (T4b)

In this study, the authors evaluated the clinical presentation of patients with T4b breast carcinoma, analyzed the impact of noninflammatory skin involvement on long-term survival, and addressed the question whether the T4 tumor category still has any justification. The clinical course of a study group of 119 patients with skin involvement was compared with the outcome of a control group of 299 consecutive patients who had tumors of the same size but without skin involvement. All tumors were stratified into 1 of 4 subsets according to greatest tumor dimension, as follows: Group A, < or = 3.0 cm; Group B, 3.1-5.0 cm; Group C, 5.1-10.0 cm; and Group D, > 10.0 cm. The study group distribution of patients within the size subsets were as follows: Group A, 26.1%; Group B, 24.3%; Group C, 26.1%; and Group D, 23.5%. Differences in disease-specific survival between the tumor size subsets were significant (Groups A and B vs. Groups C and D; P < 0.0001). In contrast to large tumors (> 5.0 cm), carcinomas < or = 5.0 cm showed no statistical significant differences in disease-specific survival between study group patients and control group patients (Group A: P = 0.17; Group B: P = 0.31). There is a broad range of clinicopathologic breast carcinoma entities within the T4b category. For > 50% of patients with T4b breast carcinoma, the feature noninflammatory skin involvement had no significant prognostic impact. Approximately 25% of patients had an extent of disease similar to that observed in patients with Stage I-II disease and, thus, falsely were considered to have more advanced disease. Heterogeneity and a lack of prognostic significance suggest that a revision of the T4 category, a relic of historic tumor classifications, is necessary.

Efficacy and treatment-related toxicity of radiotherapy for early-stage primary non-Hodgkin lymphoma of the parotid gland

To assess the efficacy of radiotherapy (RT) in the treatment of primary non-Hodgkin lymphoma (NHL) of the parotid gland. Data on 35 consecutive patients seen at Mayo Clinic between 1974 and 2000 with Ann Arbor Stage I and II NHL of the parotid gland were reviewed retrospectively. Radiotherapy was given to 23 patients, and 12 patients were observed. Eight patients received RT to local fields only. In addition to local fields, 9 patients received ipsilateral neck irradiation, and 6 patients received both ipsilateral and contralateral neck irradiation. Median follow-up was 6.5 years (range, 2 months-24 years). Local control was significantly improved in the RT group compared with the observation group (p = 0.03). Both overall survival and disease-specific survival were 90% at 5 years and 71% at 10 years. There was no significant difference in disease-specific survival or overall survival between the RT and observation groups. The overall prognosis for this rare presentation of NHL is excellent. Radiotherapy provided significant improvement in local control with minimal morbidity and should be considered in the treatment of these patients.

Breast cancer in elderly women

Although the number of elderly patients with breast cancer is increasing, knowledge about possible differences in the biology and clinical outcomes of breast cancer according to age is limited. Retrospectively were followed: diagnosis, surgical treatment, stage of disease, histology, and survival of breast cancer treated women at the Surgical and Oncological Clinic in Nis between 1985 and 1990. Patients were divided in two groups: study (=65 years) and control (<65 years). The study involved 2196 women (862 study group; 1334 control group). Ductal carcinoma was the most frequently observed histological type (70.3% versus 61.92%). The majority of our patients presented with early-stage disease (69.02% versus 60.20%). Estrogen receptor positive tumors occurred in 67.88% of elderly patients versus 28.42% of young cases, and negative axillary lymph nodes were observed in 45.78 and 34.40% of patients in the elderly and young group, respectively. Modified radical mastectomy was selected by a large proportion of patients in both groups. Adjuvant radiation and chemotherapy were more frequently performed in the younger group ( P < 1 × 10 −8). There is no significant difference in disease-specific survival by age. In our population the presentation, surgical treatment, and survival from breast cancer is similar in older and younger women.

Prognostic factors in pancreatic endocrine neoplasms: an analysis of 136 cases with a proposal for low-grade and intermediate-grade groups.

In some organs (eg, the lung), endocrine tumors are classified on the basis of mitotic rate and necrosis. The purpose of this study was to evaluate prognostic factors in pancreatic endocrine neoplasms recently treated at a single institution. In 136 patients undergoing surgery from 1979 to 1998, the influence on disease-free survival (DFS) and disease-specific survival (DSS) of tumor size, mitotic rate, vascular invasion, necrosis, metastases, and nuclear grade was determined. Cases were further grouped according to an existing proposed classification system and then regrouped on the basis of mitotic rate (< 2 mitoses per 50 high-power fields v higher) and necrosis (present or absent) into low- and intermediate-grade groups. Correlations with DFS and DSS in univariate analysis included < or = 2 mitoses per 50 high-power fields (P =.001, P =.002), vascular invasion (P =.02, P =.04), size < or = 2 cm (P =.01, P =.05), metastases (P =.0002, P =.07), necrosis (P =.002, P =.16), and nuclear grade (P =.04, P =.33), respectively. By multivariate analysis, for DFS, tumor necrosis and presence of metastases retained significance (P =.01, P =.04, respectively). For DSS, only mitotic rate was a prognostic factor (P =.02). Among the 18 macroadenomas, eight borderline tumors, and 48 low-grade carcinomas, there was no significant difference in DSS between any groups (P =.3). However, in evaluating our newly proposed groups, the differences in DFS and DSS between low- and intermediate-grade groups were highly significant (P =.0007, P =.006, respectively). Pancreatic endocrine neoplasms exhibit a spectrum of biologic behavior, and the proposed benign (macroadenoma) and borderline groups contain potentially aggressive tumors. An alternative system based on mitotic rate and necrosis correlates strongly with survival without specifically designating any group as benign.

Relationship of p21(WAF-I) protein expression with prognosis in advanced prostate cancer treated by androgen ablation.

The objectives of our study were (1) to characterize the expression of p21 and p53 proteins in advanced stage prostate cancer, (2) to determine the relationship between p53 and p21 protein expressions, and (3) to relate p53 and p21 expression to clinical outcome after androgen ablation. Seventy-five patients with advanced prostate cancer (clinical stage C: 11, stage D1: 8, stage D2: 56), who all underwent androgen ablation, had tissue specimens obtained prior to hormonal therapy and studied immunohistochemicaly for p53 (Mab D07) and p21 (Mab EA10) expression. Clinical outcome was analyzed using the Kaplan-Meier method and log-rank tests. Cox proportional hazard model was used to determine the independence of multiple variables. About 33.3% of cases expressed p53 and 33.3% expressed p21 positive immunoreactivity. No statistically significant correlation between p21 and p53 expression either in the entire study group (N = 75) or in stage D2 cases (N = 56) was observed (P = 0.38 and P = 0.68, respectively). Disease-specific survival was significantly related to p21 expression (P = 0.0006 for entire study group and P = 0.01 for D2 cases). There was no statistically significant differences in disease-specific survival between p53 positive or negative cases (P = 0.38 overall, P = 0.7 stage D2 only). p21 expression and the number of bone lesions were independently associated with shorter survival (multivariate P = 0.001, P = 0.005, respectively). The data suggests that p21 expression is a strong and independent poor prognostic factor in patients with advanced stage prostate cancer treated by androgen ablation.

Analysis of treatment results for floor-of-mouth cancer.

This study reports the results of treating floor-of-mouth cancer with five different treatment modalities with long-term follow-up. Retrospective study of 280 patients with floor-of-mouth cancer treated in the Department of Otolaryngology-Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Patients with biopsy-proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5-year follow-up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine statistical significance. The overall 5-year disease-specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5-year cumulative disease-specific survival (CDSS) was 0.61 (Kaplan-Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty-eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Significantly improved 5-year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5-year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cNO) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.

A Limited Role for Adjuvant Radiotherapy after the Wertheim/Okabayashi Radical Hysterectomy for Cervical Cancer Confined to the Cervix

Background. The indications for radiotherapy after radical hysterectomy for early stage cervical cancer are changing. In the past only tumor outside the cervix was considered an indication for radiotherapy. Today adjuvant radiotherapy is also considered for an “intermediate-risk” group with tumor confined to the cervix but poor prognostic primary tumor parameters such as large tumor diameter, vascular space invasion, and deep stromal penetration.Objective. The aims of this study were to determine the risk of isolated pelvic recurrences in an intermediate-risk group (GOG Study No. 92) and to analyze whether this group will theoretically benefit from adjuvant pelvic radiotherapy.Patients and methods. A retrospective analysis was performed on 271 patients with early cervical cancer treated by a radical hysterectomy in a uniform fashion in one institute. Radiotherapy was administered only when tumor was found outside the cervix. Tumor diameter, capillary lymphatic space invasion, and depth of stromal penetration were assessed in all patients. Recurrence pattern, disease-specific survival, and recurrence-free interval were determined in the intermediate-risk group and compared with the remaining patients of the group with tumor confined to the cervix.Results. A significant difference in disease-specific survival (89% versus 97%, P < 0.03) and 5-year recurrence-free interval (86% versus 95%, P < 0.02) was noted in the intermediate-risk group (n = 56) compared with the total group with tumor confined to the cervix. Three patients in the intermediate-risk group died of disease with a pelvic recurrence. Two of these patients had a combined pelvic and distant recurrence.Conclusion. Our retrospective results fail to support a survival benefit of extending indications for adjuvant radiotherapy other than postive nodes, parametrial extension, and positive margins.