Elective postoperative external radiotherapy after hysterectomy in early-stage carcinoma of the cervix. Is additional vaginal cuff irradiation necessary?

Abstract

This retrospective study of 44 patients who received postoperative radiotherapy soon after hysterectomy for early Stage IB to IIA carcinoma of the cervix was undertaken to determine the need for additional vaginal cuff irradiation (AVCI) following external pelvic irradiation (EPI). The reasons for adjuvant radiotherapy administration were mostly the nonradical type of performed hysterectomy or the presence of adverse prognostic histopathologic features. The overall survival and local control rates were 80% (35/44) and 89% (39/44) at 2 years and 63% (26/41) and 80% (33/41) at 5 years, respectively. Although the 2-year results seemed to indicate that AVCI was necessary, this was not supported by the obtained longer term data. Moreover, it appeared that AVCI could perhaps be safely done after EPI, when occult early-stage cervical carcinoma was found after total abdominal hysterectomy. Data from this study and the literature concerning AVCI's appropriate role in this particular disease condition are discussed.

Therapeutic Outcome and Prognostic Factors in the Radiotherapy of Recurrences of Cervical Carcinoma Following Surgery

“…Eleven of the 26 patients in our study had prognostic high risk factors in the primary situation but had not undergone postoperative pelvic irradiation for various reasons. Adjuvant radiotherapy in case of risk factors has been the usual clinical practice for early cervical carcinoma in many departments [2,12,19,33,39,45]. Many authors emphasize the value and necessity of adjuvant treatment in patients with high risk factors [4,20,26,37] like positive pelvic lymph nodes, parametric involvement, positive margins, lymph-or hemangiosis, bulky tumors, deep invasion of cervical stroma, or histology of adenocarcinoma, clear-cell or small-cell carcinoma [1,3,7,10,15,16,27,31,34].…”

“…If paraaortic lymph node metastases existed, they were treated with 46/50.4 Gy (single dose 2/1.8 Gy). (6) Positive pelvic lymph nodes (5) of the pelvic wall (16) Bulky disease (> 3.5 cm) (2) • Vagina ± paravaginal Parametric involvement (6) tissue only (7) • With infiltration of the wall of rectum or bladder (4) • With infiltration of the lymph nodes (5) -Iliac lymph nodes (1) -Iliac and inguinal lymph nodes (1) -Iliac and paraaortic lymph nodes (3) Central with infiltration of the pelvic wall (10) • Without lymph nodes (9) • With lymph nodes (1) In total, a dose of 55-65 Gy was delivered to the site of recurrence.…”

A Retrospective Six Years Analysis of Survival and Late Morbidity of Post-operative Gynaecological Malignancy Treated with External Radiotherapy Followed by Brachytherapy in Medical College & Hospitals, Kolkata

“…Ampil et al [9] described results in 44 patients who received post-operative irradiation after hysterectomy for stage IB or IIA cervical cancer (15 patients were treated with radical hysterectomy). They suggested that the combination of external radiation with additional vaginal cuff irradiation is recommended for patients treated with simple hysterectomy.…”

Prise en charge chirurgicale par voie d'abord cœlioscopique du cancer du col utérin occulte découvert après hystérectomie simple

“…Dans une étude sur 90 patientes traitées par radiothérapie après hystérectomie simple inadaptée (cancer du col de stades Ib à IIb), Hsu retrouve un taux de complications tardives de 15,5 %, dont seulement 1 % nécessitant une prise en charge chirurgicale [41]. L'intérêt d'associer une curiethérapie à la radiothérapie externe est discuté par certains auteurs qui attirent l'attention sur une augmentation du taux de complication sans bénéfice thérapeutique évident [21,34,43]. Pour l'approche chirurgicale, le taux de complication peropé-ratoire (plaies viscérales, transfusions) varie de 5,5 à 35 % et le taux de complication à long terme (troubles urinaires essentiellement) de 0 à 8,7 % [14][15][16][17].…”