The Role of Pelvic Irradiation after Hysterectomy in Early Stage Cervical Carcinoma with Pelvic Nodal Metastasis

摘要

PURPOSE: To determine the role of pelvic irradiation in stage I or IIA cervical carcinoma with pelvic nodal metastasis after hysterectomy and bilateral pelvic lymphadenectomy. MATERIAL AND METHODS: This is a retrospective study of 68 cervical carcinoma patients who were found to have pelvic nodal metastasis at hysterectomy and received pelvic irradiation from 1983 to 1996 at Inje University Seoul Paik Hospital. External beam radiation therapy to pelvis was delivered using 4 MeV Linac and intracavitary irradiation was given via vaginal ovoids or cylinders. Five-year survival and disease-free survival were estimated by Kaplan-Meier Method and prognostic factors related to survival were analysed by log-rank test and Cox proportional hazards regression model. RESULTS: Median length of follow-up was 52months. Five-year overall survival and disease-free survival (DFS) were 81.8% and 81.7% respectively. Patients with endometrial invasion had a 57.1% 5-year DFS compared to 87.5% for those without endometrial invasion (p=0.0074). Multivariate analysis revealed endometrial invasion as an only statistically significant prognostic factor for 5-year DFS. Among total 15 (22%) recurrences, pelvic recurrences occcured in 4 cases and distant metastases occurred in 13 cases. CONCLUSION: We have been able to confirm previous results demonstrating marked decrease in local recurrence after pelvic irradiation. In view of the high proportion of distant metastasis found in this study, a trial of aggressive adjuvant systemic therapy and irradiation in early stage cervical carcinoma patients with pelvic nodal metastasis, especially with endometrial invasion, appears to be warranted.