Results of radical surgical procedures after radiation for treatment of invasive carcinoma of the uterine cervix in a private practice

An analysis is made of the results of treatment of 96 women with carcinoma of the cervix, Stages IB and II, in a private practive. All 96 women were treated preoperatively with uterine intracavitary radium, followed 6 weeks later by Wertheim hysterectomy with pelvic lymphadenectomy. If malignant tumor was present in the lateral pelvic lymph nodes, external radiation was given postoperatively. The over-all survival rates were: Stage IB, 88% and 84% at 5 and 10 years; Stage II, 72% and 62% at 5 and 10 years. Regardles of the clinical stage, the highest survival rates were found in those patients who had no malignancy in the lateral pelvic lymph nodes and no residual cervical carcinoma. The lowest survical rates were found in those patients who had both residual cervical carcinoma and lymph node metastases.     

Treatment of primary invasive cervical cancer. Considerations on 997 consecutive cases

From 1965 to 1979 997 consecutive cervical cancer patients were treated at the University of Brescia. Stage I B and II A low risk patients underwent radical surgery, followed by Co60 external pelvic radiation when positive nodes and/or adverse pathological factors on the specimens were encountered. In stage I B the 5-year survival was 95.9% and 82.7% in the two groups and in stage II A 93.3% and 76.5% respectively. Bulky and large tumors were treated by intracavitary radium followed by radical hysterectomy and, if indicated, by Co60 external beam pelvic radiation. All other patients and all stage II B were treated by radiotherapy. The results of primary radical surgery may reflect the favourable preselection of cases. Postoperative radiation teletherapy in case of adverse pathological factors is of benefit to the patients.     

Radiation injury to intestine following hysterectomy and adjuvant radiotherapy for cervical cancer

OBJECTIVE: To evaluate the risk factors for nonrectal radiation-induced intestinal injury (NRRIII) following adjuvant radiotherapy (RT) for cervical cancer using a retrospective review of medical records. METHODS: From September 1992 to December 1998, 164 patients with uterine cervical cancer that had completed their allocated adjuvant radiotherapy at the Chinese Medical University Hospital were enrolled for NRRIII analysis. The patients were classified into two groups according to the extent of surgery. Group A consisted of 110 patients (International Federation of Gynecology and Obstetrics [FIGO] stage: IB, n = 87; IIA, n = 21; IIB, n = 2) undergoing radical hysterectomy and bilateral pelvic lymph node dissection, while Group B was composed of 54 analogs receiving adjuvant radiotherapy following incident extrafascial hysterectomy. Treatment consisted of external beam radiotherapy (EBRT) and high-dose-rate intravaginal brachytherapy (HDRIVB). Initially, the whole pelvis was treated with 10 MV X-rays. After irradiation (44 Gy in 22 fractions over 4-5 weeks), the field was limited to the true pelvis and a further 10-20 Gy delivered in 5-10 fractions. For 21 patients in group A without pelvic lymph node metastasis or lymphovascular invasion, the radiation field was confined to the lower pelvis, with a prescribed dose of 50-58 Gy delivered over 5-6 weeks. HDRIVB was performed using an Ir-192 remote after-loading technique at 1-week intervals. A total of 159 patients (97%) received two insertions, while 5 had only one. The standard prescribed HDRIVB dose was 7.5 Gy to the vaginal surface. Logistic regression analysis was performed for assessment of the factors associated with NRRIII. RESULTS: After 38-119 months of follow-up (median, 60), 22 patients (13.4%) developed Radiation Therapy Oncology Group (RTOG) grade 2 or greater NRRIII at a median latency of 18 months (range, 5-48). Four patients were diagnosed as grade 3 complications requiring surgery and three had expired. The independent factors for NRRIII were radical hysterectomy (P = 0.04, relative risk 2.45), lower-pelvic dose >54 Gy (P = 0.0001, relative risk 10.27), and age over 60 years (P = 0.001, relative risk 5.45). The incidence of NRRIII for patients receiving whole and lower-pelvic irradiation was 14.5% and 10.6%, respectively (P = 0.45). Although there was no statistical significance comparing the two external beam irradiation strategies in terms of NRRIII, all four patients with grade 3 NRRIII underwent whole pelvic irradiation. CONCLUSION: This study identifies three predictive factors for the development of NRRIII following adjuvant radiotherapy for cervical cancer. Limiting the EBRT dose to less than 54 Gy, meticulous patient selection in the elderly, careful planning of the irradiated field, and the constraint of vaginal brachytherapy are four approaches to optimization of postoperative adjuvant radiotherapy.     

Is lymphadenectomy useful in the treatment of endometrial carcinoma?

In our institution endometrial carcinoma stages I and II is treated with uterovaginal brachytherapy and radical hysterectomy with pelvic lymphadenectomy. We have made a retrospective analysis of the results of lymphadenectomy to determine its place in the treatment strategy. Between 1976 and 1986, 155 patients were treated with these modalities (107 were stage I, 48 were stage II). The mean age was 60.2 years. Brachytherapy delivered 60 Gy, and then radical hysterectomy with pelvic lymphadenectomy was performed. Twenty-six patients received pelvic external-beam irradiation because of lymph node involvement and or deep tumor invasion into the myometrium. Fourteen patients (9%) had lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. The lymph node involvement rate was higher for patients with stage II disease, patients with grade 3 tumors, and patients in whom there was deep tumor invasion into the myometrium. Pelvic failure rate was 12% for node-negative patients and 36% for node-positive patients. The 5-year actuarial survival rates were 83% for node-negative and 41% for node-positive patients. We administer pelvic external-beam radiotherapy to all stage II patients, grade 2 or 3 patients, and patients in whom there is deep tumor invasion into the myometrium. We do not perform lymphadenectomy on these patients. We perform only external iliac sampling for patients with stage I, grade 1 tumor without deep tumor invasion.     

Postoperative external pelvic irradiation in carcinoma of the corpus stage I: A controlled clinical trial

During the years 1968–1972, 386 patients entered a controlled clinical trial with the aim of assessing the value of external high voltage irradiation in carcinoma of the corpus Stage I. After primary surgery, all patients received intravaginal radium application delivering 6000 rads to the vaginal wall. They were then allocated to one of two groups by random numbers. Group A received no further treatment, while Group B was given 4000 rads of high voltage irradiation to a pelvic field. During a follow-up period of between 2.5 and 7 years no difference was found in the number of deaths and recurrences between the two treatment groups. The frequency of local recurrences in the vagina and the pelvis was higher in Group A. This was outweighed by a higher number of distant metastases in Group B. It is concluded that possibly only those cases with anaplastic tumours infiltrating deep in the myometrium may benefit from additional external radiotherapy.     

Can treatment of carcinoma of the cervix be individualized?

Assessment of response of cervical cancers to irradiation by the conventional histological method of biopsies done during the course of radiotherapy in 51 Stage I and early stage II patients was discussed. The prediction of response to irradiation was based on the nuclear and cytoplasmic changes in the tumor cells. Two applications of intracavitary radium or external irradiation followed by intracavitary radium were given to the patients. Wertheim hysterectomy was done 4–6 weeks after irradiation in the former and 3–4 weeks after irradiation in the latter. The accuracy of the prediction was correlated with the presence of residual growth in the surgical specimens. The prediction based on biopsies done after intracavitary radium was found to be of significance. If the patient was treated initially by external irradiation, biopsy should only be taken after 5400 rad or on completion of the whole course. Validity of this study was discussed. It was concluded that it is possible to select patients who would respond poorly to irradiation for surgery.     

Radical hysterectomy and pelvic lymphadenectomy following pelvic irradiation. Five year survival rates for the years 1930-1959

Eighty-seven Wertheim hysterectomies with pelvic lymphadenectomy performed at the University of Iowa Hospitals between 1930 and December, 1959, are reviewed. Most cases had some form of irradiation therapy preoperatively and in recent years this has been cervical radium 6 weeks prior to operation.Patients treated operatively with and without preoperative irradiation for Stage I cervical carcinoma with lesions less than 1 cm, in diameter had a 90 per cent 5 year survival. Those with a lesion greater than 1 cm. in diameter had an 81 per cent 5 year survival, and those with Stage II lesions had a 60 per cent 5 year survival. Comparative results between patients who received preoperative irradiation and those who did not could not be evaluated because of the small numbers.Patients with residual cervical carcinoma following complete radiation therapy who were treated by operation had a 75 per cent 5 year survival. Patients operated upon for recurrent cervical carcinoma had a 58 per cent 5 year survival.While we continue to feel that irradiation therapy is the treatment of choice for cervical carcinoma, the above series justifies surgical therapy in a select group of patients.     

宫颈鳞癌卵巢悬吊术后辅助放化疗对卵巢功能影响研究

目的 探讨宫颈鳞癌患者行卵巢悬吊术后辅助放化疗对卵巢功能的影响。方法 收集2008-2014年中国医科大学附属盛京医院收治的308例ⅠA~ⅡA期宫颈鳞癌行广泛性子宫切除术+盆（腹）腔淋巴清扫术+卵巢悬吊术的患者资料,按年龄（≥40岁和＜40岁）、悬吊卵巢的数量（单侧和双侧）、术后是否辅助治疗（辅助化疗、辅助放疗、辅助放化疗）分组。随访患者术后6个月情况,采用改良的围绝经期综合征量表（改良Kupperman评分表）评分,观察其卵巢功能受损症状出现情况。结果 按年龄、悬吊卵巢的数量分组之间改良Kupperman评分比较差异均无统计意义（P>0.05）。手术+放疗组、手术+放化疗组分别与手术组间改良Kupperman评分比较、手术+放疗组与手术+化疗组间改良Kupperman评分比较,差异均有统计学意义（P<0.05）。手术+化疗组与手术组,手术+化疗组与手术+放化疗组,手术+放疗组与手术+放化疗组之间改良Kupperman评分比较差异均无统计学意义（P>0.05）。结论 宫颈鳞癌行卵巢悬吊术患者术后辅助放疗或放化疗易影响卵巢的内分泌功能。年龄、悬吊卵巢的数量及术后辅助化疗与卵巢功能是否受损可能无关。     

Significance of radiotherapy in the multidisciplinary treatment of gynecological malignant tumor

Effectiveness of radiotherapy and measures for improvement of treatment were examined with regard to cervical cancer, endometrial cancer and ovarian cancer, for (1) adenocarcinoma, (2) metastatic cancer, and (3) cancer in persons of advanced age. I. (1) The prognosis of cervical adenocarcinoma is poor, but radiotherapy in combination with chemotherapy can be expected to be effective for the poorly differentiated type, metastasis to the lymph node, and deep cervical invasion. (2) Radiotherapy has limited effectiveness for endometrial cancer and needs to be employed in combination with chemotherapy for the poorly differentiated type adenocarcinoma, serous adenocarcinoma, deep uterine wall invasion, vascular invasion, and metastasis to the lymph nodes. (3) In regard to cervical cancer and endometrial cancer, identification and computation of the labeling index of S-phase cells by BrdU and examination of the localization and the changes in the appearance of tumor markers and oncogenic products showed radiosensitivity of adenocarcinoma to be poor. (4) For ovarian cancer, whole pelvic irradiation by the moving strip (MS) method in combination with chemotherapy showed satisfactory results for stage I and stage II cancers. For stage III cancers, the results was not satisfactory when the residual tumor was 2 cm or larger in size. Whole pelvic irradiation of 50-TDF or more is necessary in such cases. II. The prognosis in cases of metastasis to multiple pelvic lymph nodes is poor. For such cases, it is desirable to employ paraaortic irradiation in combination with chemotherapy, with consideration of the histologic type and progress of the cancer. III. The prognosis is poor in persons of advanced age of 70 or over.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic factors and failure pattern in lymph node-negative stage IB and II cervical carcinoma treated with radical hysterectomy and postoperative irradiation

The aim was to determine the prognostic factors and recurrence pattern in stages IB and II cervical carcinoma patients with negative pelvic lymph nodes. 224 patients with stages IB and II cervical carcinoma underwent radical hysterectomy (RH) from 1982 through 1995. Of 161 patients with negative lymph nodes, 65 patients received postoperative irradiation (RT) and 96 patients were given no further therapy according to surgical pathological findings. The overall 5-year disease-free survival was 94.1%. Two of 96 RH patients (2%) and 10 of 65 RH + RT patients (15%) had recurrence in pelvic and distant sites almost equally. Multivariate analysis revealed deep cervical invasion as the only independent prognostic factor. The 5-year disease-free survival was 98.8% for patients with shallow invasion and 85.8% for patients with deep invasion (p < 0.0001). It is worthwhile to develop new strategies for the lymph node-negative patients with deep stromal invasion.     

The possible use of colour flow Doppler in planning treatment in early invasive carcinoma of the cervix.

OBJECTIVE: To investigate the pathological significance of intra-tumoural blood flow signals detected by colour Doppler ultrasound and their association with angiogenesis in cervical carcinoma. DESIGN: A prospective cross-sectional study. SETTING: University hospital. POPULATION: One hundred and four women with Stage IB-IIA cervical carcinoma. METHODS: All women underwent radical hysterectomy and pelvic lymph node dissection. Transvaginal colour Doppler ultrasound was performed before surgery to search for arterial blood flow signals within the tumours. Tumours with a measurable intra-tumoural resistance index were defined as tumour with detectable blood flow and the others as tumour with undetectable blood flow. The microvessel density of the excised tumour was assessed immunohistochemically. The women's clinical and pathologic data were recorded. RESULTS: There were 60 tumours (58%) exhibiting detectable intra-tumoural blood flow signals. Tumours with detectable blood flow were larger, had deeper cervical stromal invasion, a higher incidence of parametrial invasion and pelvic lymph node metastases, and a higher microvessel density, when compared with those without detectable blood flow. Cervical cancers with deep cervical stromal invasion, parametrial invasion, and pelvic lymph node metastasis had higher microvessel density than those with superficial stromal invasion, no parametrial invasion, or no lymph node metastasis. Microvessel density correlated well with lymph node metastases and parametrial invasion by multiple regression analysis, while intra-tumoural blood signals only showed correlation with parametrial invasion. In the prediction of pelvic lymph node metastases and parametrial invasion, colour flow Doppler had a sensitivity of 0.80 and specificity of 0.48 in predicting lymph node metastases, and sensitivity of 0.91 and specificity of 0.57 in predicting parametrial invasion. CONCLUSIONS: The characteristics of blood flow signals in cervical carcinoma detected by colour Doppler ultrasound are associated with tumour angiogenesis and could reflect the likelihood of parametrial invasion and lymph node metastases in cervical carcinoma. The intra-tumoural blood flow signals might be used as a screening test in predicting parametrial invasion and pelvic lymph node metastases. These findings may be helpful in planning treatment for women with Stage I and II cervical carcinoma.     

Postoperative whole pelvic radiotherapy plus concurrent chemotherapy versus extended-field irradiation for early-stage cervical cancer patients with multiple pelvic lymph node metastases

Objectives

The aim of this study was to compare the efficacy of postoperative pelvic radiotherapy plus concurrent chemotherapy with that of extended-field irradiation (EFRT) in patients with FIGO Stage IA2-IIb cervical cancer with multiple pelvic lymph node metastases.

Methods

We retrospectively reviewed the medical records of patients with FIGO Stage IA2-IIb cervical cancer who had undergone radical surgery between April 1997 and March 2008. Of these, 55 patients who demonstrated multiple pelvic lymph node metastases were treated postoperatively with pelvic radiotherapy plus concurrent chemotherapy (n = 29) or EFRT (n = 26). Thirty-six patients with single pelvic node metastasis were also treated postoperatively with pelvic radiotherapy plus concurrent chemotherapy. The recurrence rate, progression free survival (PFS), and overall survival (OS) were compared between the treatment groups.

Results

Pelvic radiotherapy plus concurrent chemotherapy was significantly superior to EFRT with regard to recurrence rate (37.9% vs 69.2%, p = 0.0306), PFS (log-rank, p = 0.0236), and OS (log-rank, p = 0.0279). When the patients were treated with pelvic radiotherapy plus concurrent chemotherapy, there was no significant difference in PFS or OS between the patients with multiple lymph node metastases and those with single node metastases. With regards to grade 3-4 acute or late toxicities, no statistically significant difference was observed between the two treatment groups.

Conclusions

Postoperative pelvic radiotherapy plus concurrent chemotherapy is superior to EFRT for treating patients with FIGO Stage IA2-IIb cervical cancer displaying multiple pelvic lymph node metastases.     

Radiation and surgical treatment of cancer of the cervix uteri in proximal stages I and II

No results from therapeutic trials describing the best therapeutic procedure for cervical carcinoma in stages I and IIa are available. Analysis of a series of 242 cases of cervical carcinoma in stages I and IIa, from 1975 to 1980, treated with radical surgery and radiation therapy, yields a therapeutic approach that envisions the most reliable evaluation of subclinical extension, cure of cervical tumor and prevention of pelvic or extra-pelvic metastases with a minimum of post-radiation problems. The choice of combination surgery and radiation therapy is primarily determined by staging and the volume of the central pelvic tumor. For stages I and IIb (upper third of vagina involved) with central pelvic tumor less than 4 cm in diameter, the usual procedure is recommended i.e. radium application, total hysterectomy with pelvic lymphadenectomy followed by external irradiation of pelvic lymphatics in cases with lymphadenopathy. For stages IIb (obvious parametrial involvement) and for stages I or II with central pelvic tumor between 4 and 6 cm in diameter: total dose external and internal pelvic radiation therapy followed by total hysterectomy without pelvic lymphadenectomy but with exploration of obturator, hypogastric, external iliac, common iliac, and aortic nodes. For the rare supravaginal central pelvic tumors greater than 6 cm in diameter, the risk of clinical evaluative error and incomplete sterility by irradiation alone, warrants first an explorative laparotomy using Wertheim's procedure, then pelvic lymphadenectomy and exploration of pelvic and aortic lymph nodes.     

Five-year survival in patients given intra-arterial chemotherapy prior to radiotherapy for advanced squamous carcinoma of the cervix and vagina

Five-year survival studies in patients with advanced gynecologic pelvic malignancy treated with intra-arterial chemotherapy followed by radiotherapy have not been reported in the literature. Forty-six evaluable patients entered into a study between 1981 and 1985 at the University of Texas-M.D. Anderson Cancer Center were reviewed for follow-up. Two patients were FIGO (International Federation of Gynecology and Obstetrics) Stage IIB cervical cancer, thirty-one patients were Stage III cervical cancer, seven patients were Stage IVA cervical cancer, and six patients were unstaged, cut-through cervical cancer, or primary vaginal carcinoma with bulky tumor volume. Seventeen patients had evidence of obstructive uropathy by intravenous pyelogram. Pretreatment lymphangiogram was carried out in 32 patients, 14 of whom were positive for pelvic lymph node involvement. Forty-four patients had received no prior therapy before initiating intra-arterial chemotherapy. Thirty-five (76%) of the patients responded to locally infused pelvic intra-arterial chemotherapeutic agents consisting of mitomycin-C, bleomycin, and cisplatin. Vincristine was given peripherally by intravenous access. There were 24 (52%) partial responders, 11 (24%) complete responders, and 11 (24%) nonresponders. Two (4%) patients progressed during treatment, while twenty-six (57%) patients relapsed after receiving chemotherapy followed by radiotherapy. Three additional patients died from treatment-related causes, one secondary to renal failure, one to massive pulmonary embolus, and one from a combination of pulmonary toxicity secondary to bleomycin and sepsis. Three of fifteen patients in complete remission died from unrelated causes with no evidence of disease. The 5-year survival rate for the study group was 30%, with a median survival duration of 18 months.     

Nerve-sparing radical hysterectomy for stage IA2-IIB cervical cancer: 5-year survival of 501 consecutive cases

OBJECTIVE: The purpose of this study was to assess the 5-year survival and morbidity in cases with radical hysterectomy and pelvic lymphadenectomy with pre- and postoperative irradiation performed to treat Stage IA2-IIB cervical cancer. METHODS: During a 10(1/2)-year period between July 1990 and December 2000, 501 consecutive radical hysterectomies with bilateral pelvic lymphadenectomy were performed by the same gynecological surgeon in Stage IA2, IB, IIA and IIB cervical cancer. The patients were treated by pre- and postoperative irradiation as well. RESULTS: Apart from recurrence, perioperative complications were minimal with no long-term morbidity. The absolute 5-year survival rates for the patients in Stage IA2, IB1, IB2, IIA and IIB were 94.4%, 90.7%, 84.1%, 71.1%, and 55.4%, respectively. The respective 5-year survival rates for patients without or with lymph node metastasis were 94.5% and 33.3% in Stage IB2, 81.7% and 48.7% in Stage IIA and 70.2% and 36.5% in Stage IIB, respectively. CONCLUSIONS: Nerve-sparing radical hysterectomy with pelvic lymph node dissection and pre- and postoperative irradiation remains the treatment of choice for most patients with early-stage and even Stage IIB cervical cancer. The radicalism and extent of lymph node dissection and parametrial resection should be individualized and tailored to tumor- and patient-related risk factors.     

Prognostic significance of morphology of tumor and retroperitoneal lymph nodes in epithelial carcinoma of the ovary: I. Correlation with lymph node metastasis

The prognostic indices based on a morphologic study of tumor and retroperitoneal lymph nodes in 63 patients with epithelial carcinoma of the ovary are reported. The purpose of the study was to identify those variables most frequently related to nodal involvement. The cases in the series consisted of 11 Stage I, 10 Stage II, 34 Stage III, and 8 Stage IV. Histologic distribution was 60.4% serous type, 11.1% mucinous, 6.3% endometrioid, 6.3% clear cell and 15.9% unclassified. All patients had maximal surgery and selective biopsy of para-aortic and pelvic lymph nodes. The results showed statistically significant variables associated with nodal metastasis in both primary tumor and regional lymph nodes. The indices in primary tumor were grade of tumor, vascular invasion, lymphocytic infiltration, and stromal fibrosis; those in lymph node were type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation. The nodes with lymphocyte depletion were associated with nodal spread in 81.3% of cases. It is concluded that morphologic study of tumor and lymph node could identify prognostic factors predicting regional nodal metastasis in ovarian carcinoma.     

Pelvic and paraaortic lymph node metastasis in clinical stage I endometrial adenocarcinoma: an analysis of 58 consecutive cases

OBJECTIVE: The aim of this study was to evaluate the importance of complete surgical-pathologic staging in clinical Stage I endometrial adenocarcinomas. METHODS: 58 consecutive women with clinical Stage I endometrial adenocarcinomas were investigated. RESULTS: Isolated paraaortic lymph node invasion was found in one patient without pelvic node invasion (5%). CONCLUSIONS: We recommend a complete lymphadenectomy instead of selective lymphadenectomy. With this practice the real stages of the cases can be determined and over treatment can be avoided.     

Ⅱb期宫颈癌的治疗

144例Ⅱb期宫颈癌患者分为6组,a组23例因盆腔淋巴结未检出癌灶仪行根治手术。b组21例因盆腔淋巴结有癌灶,术后加体外放疗。c组36例、d组14例系化疗加根治术治疗,化疗多是经动脉灌注5-Fu及噻替派,无盆腔淋巴结转移者仅化疗—疗程,阳性者化疗二疗程。e组36例、f组14例为对照组接受标准放疗。6组5年生存率分别为86.9%、76.2%、80.5%、50.0%、61.1%和42.9%。     

Uterine sarcoma: an analysis of 74 cases

In order to determine whether recent methods of diagnosis and treatment have resulted in an improved survival for patients with uterine sarcoma, we reviewed 99 cases treated in our center from 1970-1985. Morphologic characteristics of 74 tumors were specifically reassessed for this study. All tumors were graded. Of 42 Stage I cases that were morphologically assessed, tumor-positive pelvic lymph nodes were found in two of the 15 patients in whom sampling was done. No cases of tumor-positive para-aortic nodes were found in 14 patients with Stage I disease. In Stage I and Stage II, no cases of positive para-aortic nodes were found in association with negative pelvic nodes. The 2- and 5-year survival rates in Stage I were 47.4% and 29.4%, respectively. Local recurrence decreased (p less than 0.01) in Stage I from nine of 22 cases in which operation alone was performed to none of 15 cases in which pelvic radiotherapy was added, but no improvement in the 5-year survival rate was observed. As with lymphadenectomy and radiotherapy, the recent use of chemotherapy for uterine sarcoma had no impact on survival.     

Early stage cervical cancer with negative pelvic lymph nodes: pattern of failure and complication following radical hysterectomy and adjuvant radiotherapy

PURPOSE OF INVESTIGATION: The objective was to optimize the adjuvant treatment for patients with lymph node negative cervical cancer by analyzing patterns of failure and complications following radical hysterectomy and adjuvant radiotherapy. METHODS: From September 1992 to December 1998, 67 patients with lymph node negative uterine cervical cancer (FIGO stage distribution: 50 Ib. 17 IIa), who had undergone radical hysterectomy and postoperative adjuvant radiotherapy with a minimum of three years of follow-up were evaluated. All patients received 50-58 Gy of external radiation to the lower pelvis followed by two sessions of intravaginal brachytherapy with a prescribed dose of 7.5 Gy to the vaginal mucosa. For 21 patients with lymphovascular invasion, the initial irradiation field included the whole pelvis for 44 Gy. The data were analyzed for actuarial survival (AS), pelvic relapse-free survival (PRFS), distant metastasis-free survival (DMFS), and treatment-related complications. Multivariate analysis was performed to assess the prognostic factors. RESULTS: The respective five-year AS, PRFS, and DMFS for the 67 patients were 79%, 93% and 87%. Multivariate analysis identified two prognostic factors for AS: bulky tumor vs non-bulky tumor (p = 0.003), positive resection margin (p = 0.03). The independent prognostic factors for DMFS was bulky tumor (p = 0.003), while lymphatic permeation showed marginal impact to DMFS (p = 0.08). The incidence of RTOG grade 1-4 rectal and non-rectal gastrointestinal complication rates were 20.9% and 19.4%, respectively. The independent prognostic factor for gastrointestinal complication was age over 60 years (p = 0.047, relative risk 4.1, 95% CI 1.2 approximately 11.7). The incidence of non-rectal gastrointestinal injury for the patients receiving whole pelvic radiation and lower pelvic radiation was 28.5% and 15.2%, respectively (p = 0.25). CONCLUSION: For patients with lymph node negative cervical cancer following radical hysterectomy, adjuvant lower pelvic radiation appears to be effective for pelvic control. It is also imperative to intensify the strategies of adjuvant therapy for some subgroups of patients.