Published: 2019-01-25

Early stage cervical cancer with negative pelvic lymph nodes: morbidity and survival patterns following radical hysterectomy and postoperative adjuvant radiotherapy

Ruchi S. Arora, Shilpa M. Patel, Ava D. Desai, Meeta M. Makand


Background: The objective of the present study was to optimize the role of adjuvant radiotherapy in lymph node negative cervical cancer treated with radical hysterectomy and pelvic lymph node dissection, and to analyse patterns of failure and complication following surgery and radiotherapy in same patients.

Methods: This is retrospective analysis of 98 patients of cancer cervix FIGO Stage IB; IIA treated with radical hysterectomy with bilateral lymphadenectomy and adjuvant radiotherapy between the years 2000 and 2007at our hospital. Among all node negative patients who were operated during this period 97 patients were high risk. [High risk-Two or more of following risk factors: primary tumor size >4 cm, cervical stromal invasion ≥1/2, lymph-vascular space invasion, Unfavorable histology,>].

Results: Median follow up: 79 months [6 months to 109 months], Recurrence rate: 13.26% [2 Pelvic and 11 distant recurrence] Pelvic control rate: 98 %Radiotherapy Complications: 4 % [Grade 3-4].

Conclusions: Adjuvant radiotherapy following radical hysterectomy in high risk node negative early cervical cancer is effective treatment. It reduces pelvic recurrence with acceptable morbidity.


Cervical cancer, Negative lymph nodes, Prognostic factors, Radiotherapy, Survival

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Torre LA, Siegel RL, Ward EM, Jemal A. Global cancer incidence and mortality rates and trends--an update. Cancer Epidemiol Biomarkers Prev. 2016; 25(1):16-27.

Yeh SA, Leung SW, Wang CJ, Chen HC. Postoperative radiotherapy in early stage carcinoma of the uterine cervix: Treatment results and Prognostic factors. Gynaecol Oncol 1999; 72(1):10-15.

Lai CH, Hong JH, Hsueh S, Ng KK, Chang TC, Tseng CJ, et al. Preoperative prognostic variables and the importance of postoperative adjuvant therapy on the outcomes of stage IB or II cervical patients with or without pelvic lymph node metastasis: an analysis of 891 cases. Cancer. 1999;85(7):1537-46.

Peters III WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18(8):1606-13.

Fuller Jr AF, Elliott N, Kosloff C, Hoskins WJ, Lewis Jr JL. Determinants for increased risk of recurrence in patients of the cervix. Gynaecol Oncol 1989;13:33-34.

Delgado G, Bundy B, Zaino R, Sevin B, Creasman WT, Major E. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: A gynaecologic oncology group study. Gynaecol Oncol 1990;38(3):352-7.

Burke TW, Hoskins WJ, Heller PB, Bibro MC, Weiser EB, Park PC. Prognostic factors associated with radical hysterectomy failure .Gynecol Oncol 1980; 26(2):153-9.

Samlal RA, van der Velden J, Ten Kate FJ, Schilthuis MS, Hart AA, Lammes FB. Surgical pathological factors that predict recurrence in stage IB and IIA cervical carcinoma patients with negative pelvic lymph nodes. Cancer 1997;80(7):1234-40.

Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Munderspach LI, Zaino RJ. A Randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage Ib carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologi Oncology Group Study. Gynecol Oncol. 1999;73(2):177-83.

Vavra N, Sevelda P, Seifert M, Timar J, Kudielka I, Kucera H, et al. The value of adjuvant irradiation in lymphatic vessel invasion in patients with a cervical carcinoma in histopathological stage Ib and with negative lymph nodes. Strahlenther Onkol.1992; 168(9):524-7.

Schorge JO, Molpus KL, Koelliker D, Nikrui N, Goodman A, Fuller AFJr . StageIB and IIA cervical cancer with negative lymph nodes:the role of adjuvant radiotherapy radiotherapy after radical hysterectomy. Gynaecol Oncol. 1997;66(1):31-5.

Sartori E, Tisi G, Chiudinelli F, La Face B, Franzini R, Pecorelli S. Early stage cervical cancer: Adjuvant treatment in negative lymph node cases. Gynaecol Oncol 2007;107(1):S170-4.

Ayhan A, Al RA, Baykal C, Demirtas E, Ayhan A, Yüce K. Prognostic factors in FIGO stage IB cervical cancer without Lymph node metastasis and the role of adjuvant radiotherapy after radical hysterectomy. Int J Gynecol Cancer. 2004;14(2):286-292.

Kodaira T, Fuwa N, Nakanishi T, Kuzuya K, Sasaoka M, Furutani K et al. Retrospective analysis of postoperative radiotherapy for node negative cervical carcinoma with stage Ib-IIb disease. Jap J Clinic Oncol. 2002;32(7):255-61.

Takamura A, Mizoe J, Arimoto T, Kamada T, Shirato H, Matsuoka Y, et al . Is postoperative radiotherapy beneficial in the management of stage I-II squamous cell carcinoma of the uterine cervix with negative nodes and positive parametrial involvement? A retrospective review of 70 patients. Asia Oceania J Obstet and Gynaecol. 1993;19(2): 145-51.

Kridelka FJ, Berg DO, Neuman M , Edwards LS, Robertson G, Grant PT, et al. Adjuvant small field pelvic radiation for patients with high risk ,stage IB lymph node negative cervix carcinoma after radical hysterectomy and pelvic lymph node dissection.a pilot study. Cancer 1999;86(10):2059-65.

Sang-YoungRyu, Sang-Il Park,Byung-Ho Nam etal Is Adjuvant chemoradiotherapy overtreatment in cervical cancer with intermediate risk factors? Int J Radiation Oncol Biol Phys. 2011;79(3):794-9.