Evolving strategies in adjuvant treatment for stage IB cervical cancer after radical hysterectomy

Objective: In stage IB cervical cancer patients after radical hysterectomy adjuvant radiation therapy is usually performed in node-positive subjects or patients with unfavourable prognostic factors on the surgical specimen. The aim of this paper is to retrospectively analyze the patterns of failure and survival in patients with stage IB cervical cancer after radical hysterectomy in relation to the main prognostic factors in view of the evolving strategies in adjuvant treatment. Methods: Site of recurrence and survival data were reviewed for 215 stage IB cervical carcinoma patients after radical surgery in a 10-year period. The incidence of positive nodes was 25.2%. All patients with positive nodes but one, and 72/161 (44.7%) with negative nodes and unfavourable prognostic factors underwent adjuvant radiation therapy. Results: The actuarial 5-year disease-free survival rate was 59.2% for the node-positive patients and 87.5% for the node-negative ones. Recurrence rate was 12.4% (20/161) in node-negative patients and 33.4% (18/54) in node-positive ones. There were 19 pelvic and 19 distant relapses, but there was a different behaviour between node-negative (14 pelvic and 6 distant) and node-positive cases (5 pelvic and 13 distant). The actuarial 5-year survival for relapsing patients was 22% for those with pelvic recurrences and 4% for patients with distant metastases. Conclusions: Our present policy in node-positive patients, given the higher incidence of distant metastases, is the use of chemotherapy as adjuvant treatment. In all node-negative subjects, but in positive parametria and positive margin cases, no adjuvant therapy is employed after radical surgery. Further studies should be designed to confirm this approach.