Postoperative radiation therapy for stage IB-IIB carcinoma of the cervix with poor prognostic factors.

BACKGROUND To investigate failure pattern and to evaluate the prognostic impact of lymph node metastasis in patients with cervical cancer treated with postoperative adjuvant pelvic irradiation. MATERIALS AND METHODS Ninety-eight patients with FIGO IB to IIB cervical cancer were treated with radical hysterectomy, bilateral pelvic lymphadenectomy and postoperative radiation therapy. All the patients had at least one of the following pathologic risk factors for pelvic recurrence; 1) positive margins, 2) positive pelvic lymph nodes other than common iliac node, 3) deep stromal invasion more than 50% or parametrial invasion. RESULTS The 5-year overall survival (OAS) rate for the entire patient group was 82%. Causes of the first failure were pelvic recurrence in 5 cases and distant metastasis in 15 cases. Fifteen of the 47 patients with positive pelvic lymph nodes developed distant metastasis, whereas distant metastasis was noted in only 1 of 51 patients without lymph node metastasis. The 5-year OAS rates for patients with and without pelvic lymph node metastasis were 76% and 89%, respectively (p = 0.018). CONCLUSION Despite receiving postoperative pelvic irradiation, apparently lower survival was observed for node positive patients.

背景 研究宫颈癌患者术后辅助盆腔放疗的失败模式，并评估淋巴结转移对预后的影响。 材料与方法 98例国际妇产科联盟（FIGO）ⅠB - ⅡB期宫颈癌患者接受了根治性子宫切除术、双侧盆腔淋巴结清扫术以及术后放疗。所有患者至少具备以下一种盆腔复发的病理危险因素：1）切缘阳性；2）除髂总淋巴结外的盆腔淋巴结阳性；3）间质深部浸润超过50%或宫旁浸润。 结果 整个患者组的5年总生存率为82%。首次失败的原因包括5例盆腔复发和15例远处转移。47例盆腔淋巴结阳性患者中有15例发生远处转移，而51例无淋巴结转移的患者中仅有1例发生远处转移。有盆腔淋巴结转移和无盆腔淋巴结转移患者的5年总生存率分别为76%和89%（p = 0.018）。 结论 尽管接受了术后盆腔放疗，但淋巴结阳性患者的生存率明显较低。