Analysis of the effect of adjuvant radiotherapy on outcomes and complications after radical hysterectomy in FIGO stage IB1 cervical cancer patients with intermediate risk factors (GOTIC Study)

Abstract

BackgroundThere are no definitive criteria for identifying which patients with The International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer will benefit from adjuvant therapy after radical hysterectomy. The aims of this study were to clarify the efficacy of adjuvant therapy and assess complications after radical hysterectomy in patients with FIGO stage IB1 cervical cancer with intermediate risk factors.MethodsBetween January 2005 and December 2009, the medical records of 75 stage IB1 patients’ intermediate risk factors (i.e., tumor size 2–4 cm, lymphovascular involvement, and/or deep stromal invasion >1/2) who underwent radical hysterectomy at six institutions were collected, and these patients were enrolled in this nonrandomized retrospective study. We simplified the criteria of intermediate risk factors as much as possible, as the criteria adopted in some clinical studies are complicated in practice.ResultsThe patients were grouped according to the receipt of adjuvant therapy as follows: 46 patients, no further treatment; 19 patients, external beam radiation treatment, including 9 patients who received brachytherapy; 5 patients, concurrent chemoradiotherapy (CCRT); and 5 patients, chemotherapy (CT). The clinical outcomes and complications in each group were analyzed. After an average follow-up of 82.6 months (range, 24–135 months), only one patient with all three risk factors who received radiotherapy (RT) experienced recurrence. Excluding this patient, the remaining patients who received RT, CCRT, or CT had two or three risk factors. Lymphedema was significantly more common among patients who received RT or CCRT, whereas the incidence of ileus and ureteral obstruction was not different among the treatment groups. However, an unsutured peritoneum increased the risk of ileus.ConclusionsThe findings of this study suggest that RT and CCRT after radical hysterectomy are not beneficial in patients with intermediate risk factors. In particular, RT and CCRT appeared to increase the incidence of lymphedema. A prospective randomized study is needed to verify the findings of this study.

Multi‐institutional phase II study of neoadjuvant irinotecan and nedaplatin followed by radical hysterectomy and the adjuvant chemotherapy for locally advanced, bulky uterine cervical cancer: A Kansai Clinical Oncology Group study (KCOG‐G1201)

“…For example, Nakamura et al . suggested that lymphedema was significantly more common in patients who received RT or CCRT after radical hysterectomy . Other investigators also showed postoperative obstruction was significantly more frequent in patients who received RT after surgery .…”

Lower Body Lymphedema in Patients with Gynecologic Cancer

“…Like in EC, post-operative radiotherapy is associated with a higher risk of LLL (13,14,15,39,40,46,47,48), and the number of removed lymph nodes (40,49) and suprafemoral node dissection seem to be associated with a higher rate of LLL (47).…”

Effects of preoperative radiotherapy or chemoradiotherapy on postoperative pathological outcome of cervical cancer——from the large database of 46,313 cases of cervical cancer in China

“…Studies by Kazuto Nakamura and others have shown that radiotherapy can reduce local recurrence rates directly by reducing the tumour diameter and reducing the risk of deep cervical stromal invasion. [18].…”