Postoperative radiation therapy improves prognosis in patients with adverse risk factors in localized, early-stage cervical cancer: a retrospective comparative study

Abstract

The objective of this study was to assess the role of postoperative radiotherapy (RT) in early-stage cervical carcinoma with risk factors other than positive nodes, parametrial invasion, or positive margins and to compare outcomes using the Leiden University Medical Center (LUMC) modification of the Gynecologic Oncology Group (GOG) system with the GOG prognostic scoring system itself. Between January 1984 and April 2005, 402 patients with early-stage cervical cancer underwent radical hysterectomy. A total of 51 patients (13%) had two of the three risk factors and had pathologic tumor size (≥40 mm), invasion (≥15 mm), and capillary lymphatic space involvement, and were identified as the so-called high-risk (HR). We compared 34 patients who received RT based on the LUMC risk profile (67%) with 17 who did not (33%). The GOG score was calculated as well. We compared the GOG scores within the LUMC risk groups: HR+ (two out of three risk factors) and HR− (less than two out of three risk factors). Differences in 5-year cancer-specific survival (CSS) and 5-year disease-free survival (DFS) between the HR group treated with RT (86%, 85%) and without RT (57%; 43%) were statistically significant. The LUMC criteria did not significantly differ from the GOG risk profile, concerning recurrence, CSS, and DFS. HR patients benefit from adjuvant RT. The LUMC modification of the GOG system seems to be simpler and has a slightly higher threshold for the indication for RT but without a difference in outcome.

Perineural space invasion in cervical cancer (FIGO IB1-IIB) accompanied by high-risk factors for recurrence

“…[12] However, the difference was not surprising because the group of Memarzadeh et al comprised of the general population of cervical cancer patients, whereas we only included subjects with at least one of the following risk factors confirmed during a histological examination: Depth of invasion of ≥15 mm, parametrial invasion and lymph nodes involvement. [1][2][3][4] A comparison of our incidence with that reported by Memarzadeh et al, in their study revealed that risk factors increase the incidence of parametrial PSI by over two-fold. In other studies, PSI was assessed in the cervix.…”

“…[1][2][3] These factors may greatly influence the selection of patients for adjuvant therapy. [4] Perineural space invasion (PSI) qualifies for inclusion into the group of patients with poor prognostic factors. [5,6] PSI can be observed in the absence of vascular or lymphatic invasion and can be the sole route of metastatic spread.…”

Analysis of isolated loco-regional recurrence rate in intermediate risk early cervical cancer after a type C2 radical hysterectomy without adjuvant radiotherapy

“…Unfortunately these studies were either small with only 17 patients in the surgery-only arm15 or showed a better recurrence-free survival without a difference in overall survival 16 17. One of the subjects that is not often considered in the studies discussed so far is the type or quality of surgery that was used.…”

An Occult Invasive Cervical Cancer Found After a Simple Hysterectomy: A 10-Year Experience in a Single Institution

“…Based on the risk factors, the risk scoring criteria were settled through a modification of the previous criteria. 10 The final score for each patient was calculated by summing up her points, and the patient was assigned to the low-, intermediate-, or high-risk group ( Table 1). The best cutoff value for differentiating the low-risk group from the intermediate-/high-risk group was confirmed using the receiver operating characteristic (ROC) curve analysis.…”