Luigi Frigerio

Eur. J. Gynaec. Oncol. Anno XXV, N° 2, pag 132-137. 1994
( in coll. L. Busci, E. Rabaiotti, A. Mariani )
Summary: Morbidity and prognostic factors were reviewed in 145 patients who underwent radical hysterectomy and pelvic lynphadenectomy for invasive cervical cancer between January 1976 and December 1986. Ninety-five patients received adjuvant postoperative external radiotherapy ( average 4800 cGY ). One hundered 20 patients were F.I.G.O. stage IB, and 25 were clinical stage IIA. Indications for adjuvant radiotherapy included 3 categories of patients with high risk factors: 1) pelvic lymph node metastases, 2) parametrial invasion and/or surgical margins involvement, 3) large volume, deep stromal penetration or uterine extention. Four percent of the patients suffered major gastrointestinal complications, 8,9% had major genito-urinary complications, 19 patients had lymphocyts and 2 patients complained of thromoboemolic episods. Of the 19 patients with major gastrointestinal or genito- urinary morbidity, 7 (38.8%) were related to radiotherapy. Thirty-nine patients had node involvement, 38 of these patiants received radiotherapy and 5 year survival rate was 43.5% verus 87.7% in other cases ( p< 0.001). Of the 14 petients with parametral invasion and/or surgical margins involvement, 10 received radiotherapy and overall 5 years survival was 85.8%. Of the 37 patients related to third category of risk, 18 received adjuvant raditherapy with 83.3% 5 years survival versus94.7% of other 19 cases. Patients treated with surgery alone had a better 5 years survival (96%) than those who received combination therapy (66.3%) ( p< 0.001). Adjuvant raditherapy increases the morbidity of radical hysteroctomy, while it has a relative value in preventing local and distant recurrences. In view of reduced survival in high risk patients with node involvement, consideration should be given to adjuvant systemic chemotherapy in high risk cases.