Postoperative adjuvant radiotherapy following radical hysterectomy in the treatment of stage Ib II-proximal cervical cancer

In the years 1971/85, 327 patients with Stage Ib, II-proximal cervical carcinoma underwent radical hysterectomy and pelvic + lumbar-aortic lymphadenctomy. 40 patients (12.2%) who presented nodal metastases were candidates for post-operative adjuvant radiotherapy (RT), but this was not performed in 12 cases (30.0%) owing to various causes not connected with oncologic conditions. The overall N+ cases showed a 46.1% cumulative risk of pelvic relapse at 5-years and a 15.3% cumulative risk of distant metastases, against the 5.8% and 1.3% observed for the N-cases. In the group submitted to adjuvant RT the 5-year cumulative risk of recurrences was respectively 30.8% for pelvic relapse and 15.4% for distant metastases, while in the untreated group the pelvic relapse risk was 36.8% and the risk of distant metastases 21.1%. Relapse free survival (RFS) at 5-years totalled 48.8% for the N+ cases against 87.6% for the N-ones. 5-year RFS for the N+ case group was respectively 53.4% in the group submitted to adjuvant RT, against 46.7% observed for the untreated group. On the whole no statistically significant differences were observed as regards the administration of adjuvant RT. The Authors discuss the role and indications of postoperative adjuvant RT in the treatment of early stage cervical cancer, with regard to the various high risk factors.