Postoperative treatments for stage Ib-IIa cervical carcinoma with lymph node metastases after primary surgery: Complications and efficacy of three different methods

Objective: To evaluate long-term survival and complications of postoperative treatments for early cervical carcinoma with node metastases after surgery. Methods: Three treatments were utilized. Arm one (13 patients) consisted of external irradiation alone. Arm two (23 patients) included two courses of chemotherapy with vincristine, bleomycin, mitomycin c and cisplatin, followed by external irradiation. Arm three (15 patients) consisted of concurrent chemo-radiotherapy with cisplatin and external irradiation. Results: All patients received the planned sequence without severe complications. Three subjects had late bowel necrosis, one in each arm, and two (included in arm one and two) died. Another patient in arm two died of pulmonary embolism after medical treatment for subocclusion. With a minimum follow-up of five years, when patients with macroscopic residual tumor were excluded, the failure rate was 23%, 34%, and 25% in arm one, two, and three, respectively. Conclusion: The survival in the treatment arms is comparable. Multimodal treatments were feasible and tolerated. Particularly, concurrent chemo-radiotherapy appears promising.