The trend and outcome of postsurgical therapy for high-risk early-stage cervical cancer with lymph node metastasis in Japan: a report from the Japan Society of Gynecologic Oncology (JSGO) guidelines evaluation committee

Should adjuvant chemotherapy be formally studied among patients found to have pelvic lymph node metastases following radical hysterectomy with lymphadenectomy for early-stage cervical cancer?

“…In this issue of Journal of Gynecologic Oncology , Ikeda et al [ 5 ] posed a similar question. The objective of the study was to evaluate the influence of the introduction of the JSGO published guidelines (2007) for the treatment of cervical cancer on clinical trends and outcomes for patients with early-stage cervical cancer who underwent surgery.…”

“…Postsurgical management selections and outcomes were compared before the publication of the 2007 guidelines to after the publication of the guidelines. Results from the study showed that there was no significant difference in overall survival or in clinical practice trends after the introduction of the JSGO 2007 guidelines for the management of cervical cancer [ 5 ]. This study also specifically evaluated the influence of the guidelines on management and outcomes of early cervical cancer (pT1b1, pT1b2, pT2b) with positive lymph nodes.…”

“…Ikeda et al [ 5 ] also suggest that differences in surgical technique among gynecologic oncologists may also play a role in postsurgical adjuvant therapy selection. Modifications have been made to the original technique of the radical hysterectomy over time.…”

“…The 2007 JSGO guidelines recommended that patients with pelvic lymph node metastasis receive postsurgical adjuvant therapy with either whole-pelvic irradiation or chemoradiation, and that the usefulness of adjuvant chemotherapy alone was unknown. Despite these recommendations, the study found that chemotherapy tended to be increasingly selected as postsurgical treatment in patients with early cervical cancer (pT1b1, pT1b2, pT2b) with positive lymph nodes, though this trend was not statistically significant [ 5 ]. As previously mentioned, positive lymph nodes are an important prognostic factor in cervical cancer, with a recurrence rate of greater than 40% compared to patients without lymph node metastasis.…”

“…Considering these findings, systemic chemotherapy has been proposed as postsurgical adjuvant therapy to control both local recurrence and prevent distant metastatic disease. Ikeda et al [ 5 ] suggested that perhaps gynecologic oncologists considered positive pelvic lymph nodes as systemic disease that would not be sufficiently treated with local treatment with chemoradiation as was recommended by the guidelines. The benefit of chemotherapy as postsurgical treatment has not yet been clearly demonstrated [ 11 ].…”