Primary Surgical Management With Tailored Adjuvant Radiation for Stage IB2 Cervical Cancer

Hacker, Neville F. MD; Barlow, Ellen L. MN Hons; Scurry, James FRCPA; Gebski, Val MStat (Hons); Farrell, Rhonda FRANZCOG; Robertson, Greg FRANZCOG; Friedlander, Michael L. PhD; Jackson, Michael FRANZCR

doi: 10.1097/AOG.0b013e3182887836
Original Research

OBJECTIVE: To examine the outcome for patients with stage IB2 cervical cancer treated primarily with radical hysterectomy, and to determine the need for adjuvant therapy, the sites of recurrence, and the morbidity of the treatment.

METHODS: We reviewed our experience with 93 patients with stage IB2 cervical cancer treated with primary surgery at the Royal Hospital for Women in Sydney from 1988 to 2008. All patients underwent radical hysterectomy and pelvic lymphadenectomy. If bulky positive nodes were encountered, they were resected without complete lymphadenectomy. Postoperative radiation was tailored to the histologic findings.

RESULTS: The mean age of the patients was 46 years, and 70% had squamous cell carcinomas. Tumor invaded into the outer third of the cervical stroma in 73 cases (78.5%), occult parametrial extension occurred in 15 cases (16.1%), and vascular space invasion occurred in 65 cases (69.9%). Positive pelvic nodes were present in 42 patients (45.2%) and bulky positive para-aortic nodes were present in 5 patients (5.4%). Some type of postoperative adjuvant (chemoradiation) radiation was given to 74 patients (79.6%). With a median follow-up of 96 months, the overall 5-year survival was 80.7%, being 85% for patients with negative nodes and 75% for those with positive nodes (hazard ratio 2.63, 95% confidence interval 1--5.6; P=.045). The major long-term surgical morbidity was lymphedema, which occurred in eight patients (8.6%). Serious long-term radiation morbidity (Radiation Therapy Oncology Group grade 3) occurred in three patients (3.2%).

CONCLUSIONS: Primary radical hysterectomy with tailored postoperative adjuvant radiation for patients with stage IB2 cervical cancer provides good survival with acceptably low morbidity.

LEVEL OF EVIDENCE: III

Primary radical hysterectomy and tailored adjuvant external beam radiation provide good survival with acceptably low morbidity rates for patients with stage IB2 cervical cancer.

Gynaecological Cancer Centre, The Royal Hospital for Women, the School of Women's and Children's Health and the Department of Medicine, Clinical School, University of New South Wales, and the Department of Radiation Oncology, Prince of Wales Hospital, Randwick, the Hunter Area Pathology Service, Faculty of Health Sciences, University of Newcastle, Newcastle, and the National Health and Medical Research Council Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales, Australia.

Corresponding author: Neville F. Hacker MD, Gynaecological Cancer Centre, The Royal Hospital for Women, Barker St, Randwick, NSW, Australia, 2031; e-mail n.hacker@unsw.edu.au.

Ellen Barlow was supported by a grant from the GO Research Fund, an account within the Royal Hospital for Women Foundation.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists