Successful delivery after vaginal radical trachelectomy for invasive uterine cervical cancer

A 32-year-old Japanese woman was diagnosed as having stage Ib1 adenocarcinoma by diagnostic laser conization at a local hospital. She was admitted to our hospital for fertility-sparing treatment. A radical trachelectomy (RT) was performed using the laparoscopic vaginal procedure. The procedure was started with a laparoscopic pelvic lymphadenectomy. As the lymph nodes were tumor free, RT was carried out transvaginally. The excised uterine cervix and lymph nodes were pathologically negative for cancer. Eight months after the operation, the patient became pregnant without any artificial reproduction techniques. At 17 weeks of gestation, she was admitted to our hospital again for a threatened abortion. Continuous tocolytic treatment with ritodrine and daily administration of a granulocyte elastase inhibitor vaginal suppository were given. At 32 weeks of gestation, she underwent emergency cesarean section because of sudden premature rupture of the membranes. A girl weighing 1991 g was delivered, with Apgar scores of 7 and 8 at 1 and 5 min, respectively. Both the mother and the baby were discharged without trouble. This is the first successful case in Japan of delivery after vaginal RT for invasive uterine cervical cancer.     

阴式子宫颈广泛性切除术治疗早期子宫颈癌的临床疗效及对生育结局的影响

目的 探讨阴式子宫颈广泛性切除术(VRT)治疗早期子宫颈癌的临床疗效及对生育结局的影响.方法 回顾性分析并随访2005年6月至2014年5月于我院行宫颈广泛性切除术治疗的60例早期子宫颈癌年轻患者.根据手术方式分为两组:VRT组32例,腹式子宫颈广泛性切除术(ART)组28例,对两组患者的临床疗效及生育结局进行比较分析.结果 VRT组患者术中出血量明显少于ART组[(278.00±97.00) ml∶(496.00±135.00) ml,t=7.247,P＜0.05],阴道切除长度及宫旁组织切除宽度均明显短于ART组[(2.58±0.33)cm∶(3.01±0.19)cm,=6.277,P＜0.05;(2.34±0.31)cm∶(2.88±0.25) cm,t=7.357,P＜0.05].随访期间,VRT组患者复发率明显低于ART组(3.1％∶25.0％,x2 =6.18,P＜0.05).早期宫颈癌患者的复发与年龄(x2=21.33,P＜0.05)、肿瘤直径(x2=21.43,P＜0.05)、病理类型(x2=40.69,P＜0.05)及手术类型(x2=6.18,P＜0.05)有关.VRT组患者妊娠率及分娩率均明显高于ART组(37.5％∶25.0％,x2=15.33,P＜0.05;28.1％∶17.9％,x2=10.32,P＜0.05).结论 VRT治疗早期子宫颈癌安全可行,可减少手术损伤,降低复发率,并能有效保留早期子宫颈癌患者的生育功能,值得临床推广应用.     

Comparisons of vaginal and abdominal radical trachelectomy for early-stage cervical cancer: preliminary results of a multi-center research in China

Background:

There are limited data comparing the prognosis and fertility outcomes of the patients with early cervical cancer treated by trans-vaginal radical trachelectomy (VRT) or abdominal radical trachelectomy (ART).The objective of this study was to compare the surgical and pathologic characteristics, the prognosis and fertility outcomes of the patients treated by VRT or ART.

Methods:

Matched-case study based on a prospectively maintained database of patients underwent radical trachelectomy in 10 centres of China was designed to compare the prognosis and fertility outcomes of the patients treated by VRT or ART.

Results:

Totally 150 cases, 77 in the VRT and 73 in the ART group, were included. VRT and ART provide similar surgical and pathological outcomes except larger specimens obtained by ART. In the ART group, no patient developed recurrent diseases, but, in the VRT group, 7 (9.8%) patients developed recurrent diseases and 2 (1.6%) patients died of the tumours (P=0.035). The rate of pregnancy in the VRT group was significantly higher than those of ART (39.5% vs 8.8% P=0.003). The patients with tumour size >2 cm showed significant higher recurrent rate (11.6% vs 2.4%, P<0.05) and lower pregnant rate (12.5% vs 32.1%, P=0.094) compared with the patients with tumour size <2 cm.

Conclusion:

Patients treated by ART obtained better oncology results, but their fertility outcomes were unfavourable compared with VRT. Tumour size <2 cm should be emphasised as an indication for radical trachelectomy for improving the outcome of fertility and prognosis.     

Reproductive outcomes after laparoscopic radical trachelectomy for early-stage cervical cancer

Objective

The objective of this study was to estimate the reproductive outcome of young women with early-stage cervical cancer who underwent fertility-sparing laparoscopic radical trachelectomy (LRT).

Methods

We performed a retrospective review of the medical records of patients with early-stage cervical cancer who underwent LRT. Clinicopathological data were obtained from patient medical records, and reproductive outcome data were obtained from patient medical records and telephone interviews.

Results

Fifty-five patients who underwent successful LRT were included in this study. The median age of patients was 32 years (range, 22 to 40 years), and the median follow-up time after LRT was 37 months (range, 3 to 105 months). Menstruation resumed in all patients after LRT, with fifty patients (90.9%) and five patients (9.1%) reporting regular and irregular menstruation, respectively. Six patients (10.9%) presented with cervical stenosis, which was manifested by regular but decreased menstrual flow and newly-developed dysmenorrhea. These patients underwent cervical cannulation and dilatation. Eighteen patients (32.7%) attempted to conceive, with six out of 18 patients receiving fertility treatments. Fourteen pregnancies (i.e., four missed abortions, six preterm births and four full-term births) occurred in 10 patients after LRT. Nine out of 10 patients gave birth to 10 healthy babies. The pregnancy rate after LRT was 55.6% (10/18). The spontaneous abortion rate and live birth rate were 28.6% (4/14) and 71.4% (10/14), respectively. The preterm birth rate was 60% (6/10).

Conclusion

Pregnancy and live birth rates after LRT were promising; however, the preterm birth rate was relatively high. Cervical stenosis also occurred in a small percentage of patients.     

Incidence,risk factors and treatment of cervical stenosis after radical trachelectomy: A systematic review

PurposeCervical stenosis is a major and specific postoperative complication following radical trachelectomy. The current article presents a review of studies describing the incidence, risk factors and treatment methods of cervical stenosis after this fertility sparing procedure.MethodsWe searched PubMed, MEDLINE, Embase (January 1994 through November 2014) using the following terms: uterine cervix neoplasms, cervical cancer, radical trachelectomy, fertility sparing and fertility preservation. We included original articles and case series. Case reports, review articles, articles not in English and articles not mentioning cervical stenosis were all excluded.ResultsWe identified 1547 patients. The incidence rates of cervical stenosis ranged from 0% to 73.3% with an average rate of 10.5%. Among patients with abdominal, vaginal, laparoscopic and robotic radical trachelectomy, the incidences of cervical stenosis were 11.0%, 8.1%, 9.3% and 0%, respectively. In patients in whom whether cerclage was placed or not, the incidence rates of cervical stenosis were 8.6% and 3.0%, respectively (P = NS). Among those in whom whether anti-stenosis tools were placed or not, the incidences of cervical stenosis were 4.6% and 12.7%, respectively (P < 0.001). Cervical stenosis was a potential cause of infertility and increased the use of artificial reproductive technology. Surgical dilatation resolved stenosis in the majority of cases but had to be repeated.ConclusionsCervical stenosis is related to the surgical approach, cerclage and anti-stenosis tools utilised. It affects not only the quality of life but also obstetrical outcomes of patients following radical trachelectomy. Greater attention should be given to the prevention and treatment of this complication.     

广泛宫颈切除术治疗宫颈癌的手术要点及临床疗效观察

目的 探讨广泛宫颈切除术治疗宫颈癌的手术要点及临床疗效.方法 选取宫颈癌患者110例,按照手术方法不同将患者分为观察组(n=56)与对照组(n=54),观察组进行腹腔镜下广泛宫颈切除术,对照组进行开腹式广泛宫颈切除术,比较两组治疗效果.结果 观察组患者手术时间长于对照组,术中出血量少于对照组,切除淋巴结个数多于对照组(P<0.05);观察组肛门排气时间、排便时间、拔除引流管时间、抗生素使用时间、住院时间均短于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05);通过随访,两组患者复发率比较,差异无统计学意义(P>0.05),观察组生存率、妊娠率高于对照组(P<0.05).结论 在宫颈癌患者中行腹腔镜下广泛宫颈切除术效果显著,值得推广应用.     

腹腔镜在早期宫颈癌根治术中的应用效果评价

目的 探讨腹腔镜手术治疗早期宫颈癌的可行性、安全性及临床价值。方法 收集2009年1月至2014年12月在广西医科大学附属肿瘤医院妇瘤科行宫颈癌根治术的623例早期宫颈癌患者的病历资料,按手术方式分组：腹腔镜组374例,开腹组249例。回顾性分析两组患者的基本情况、手术时间、术中出血量、术中淋巴结切除数目、宫旁组织及阴道切除长度及手术并发症。结果 腹腔镜手术组成功实施368例,成功率98.40％（368／374）,中转开腹6例,中转开腹率1.60％ （6／374）。腹腔镜组在手术时间、术中出血量、术后下床活动时间、肛门排气时间均优于开腹组,差异均有统计学意义（P＜0.05）,而两组淋巴结切除数、宫旁组织和阴道切除长度比较,差异均无统计学意义（P＞0.05）。在术中及术后并发症方面,除尿潴留外,两组差异均无统计学意义（P＞0.05）。结论 腹腔镜下宫颈癌根治术较传统开腹手术创伤小、术中出血量少、术后并发症少及术后恢复快,是治疗早期宫颈癌有效、安全的方法。     

阴式广泛性宫颈切除术在宫颈癌患者中的应用效果

目的：探讨阴式广泛性宫颈切除术（vaginal radical trachelectomy,VRT）对宫颈癌患者复发和生育的影响。方法回顾性分析208例早期宫颈癌患者资料,有195例患者成功接受VRT手术,且均保留了生育功能;记录195例患者的手术指标、复发情况和生育情况,并进行随访。结果手术平均时间为（179.56±37.17） min,术中出血量为（325.79±127.54）ml,术中切除淋巴结的数目为（24.47±9.83）枚,切除宫颈的长度为（2.63±0.68）cm;出现术中并发症者有4例,出现术后并发症者8例;术后总复发率为12.31%（24/195）,复发部位以宫旁最多见（66.67%,16/24）;171例鳞癌患者中共有12例（7.02%）复发,16例腺癌患者和8例腺鳞癌患者中共有12例（50.00%）复发,复发率的差异具有统计学意义（P＜0.05）;肿瘤＞2 cm的32例患者中有13例（40.63%）复发,肿瘤≤2 cm的163例患者中有11例（6.75%）复发,差异具有统计学意义（P＜0.05）;141例患者具有妊娠的意愿,其中有55例生育,生育率为39.01%;肿瘤直径≤2 cm的患者与＞2cm的患者之间的生育率差异无统计学意义（P＞0.05）。结论 VRT在保留患者的生育功能方面是比较成熟的,肿瘤直径大于2 cm是患者术后复发的危险因素。     

根治性宫颈切除术在浸润性宫颈癌中的应用

根治性宫颈切除术(RT)被誉为宫颈癌治疗在21世纪手术发展的标志,给渴望保留生育能力的早期宫颈癌患者带了希望.手术范围包括RT及盆腔淋巴清扫术,手术方式包括阴式及腹式,疗效及可行性与标准的治疗方法相近,在临床上有较大的应用价值.     

A new method of surgical margin assuring for abdominal radical trachelectomy in frozen section

ObjectivesThe aim of this study was to introduce a new method of assuring surgical margins for abdominal radical trachelectomy (ART) and report our experience using the method.MethodsWe combined transverse and perpendicular sections to assess surgical margins of specimens from RT. All surgeries from 1st August 2012 to 1st October 2013 were performed by one surgeon. The frozen section (FS) was consistently performed by a group of gynaecologic pathologists according to the detailed protocol described in this article. All cases were prepared by the same pathologist, and the slides were reviewed by two pathologists.ResultsThere were 53 patients treated using the new method in our institution. The patient ages ranged from 20 to 41 years old (median 32). The surgeries were performed for clinical stage IA (n = 11) with LVSI and IB (n = 42) tumours (40 squamous cell carcinoma, 11 adenocarcinoma, two adenosquamous and two others). In 20 (37.74%) cases, no residual tumour of the ART specimen on frozen section was observed in the specimens as it was cleared by the preceding loop electrical excision procedure (LEEP) or conization. The margins were initially reported as negative in 45 cases and positive in nine cases. In those nine cases, a second slice of cervix was removed and negative in six cases and positive again in two cases, the other one with positive nodes. The results of frozen sections were concordant with the final paraffin-embedded sections. There were no false negative intraoperative assessments. There were no recurrences after a median follow-up of 15.4 months (range, 6–21 months).ConclusionsCombining transverse and perpendicular sections to assess surgical margins of specimens from RT makes the protocol simple, reliable and produces accurate results.     

宫颈癌保留生育功能的腹式根治性宫颈切除术——一项潜在获益人群的研究

背景与目的:宫颈癌仍是全球妇科恶性肿瘤患者的主要死因,目前国内开展根治性宫颈切除术(radical trachelectomy,RT)手术的医院较少。本研究旨在探讨早期宫颈癌患者中,适合行保留生育功能的腹式根治性宫颈切除术(abdominal radical trachelectomy,ART)的患者比例。方法:回顾性地分析了2000年1月—2007年12月,腹式根治性宫颈切除术尚未在复旦大学附属肿瘤医院广泛开展前,因浸润性宫颈癌在本院行根治性子宫切除术的患者病历。根据行根治性宫颈切除术患者的指征,研究适合行ART的潜在患者人群。结果:经筛选,2000年1月—2007年12月期间共有3 220例患者因为浸润性宫颈癌行根治性子宫切除术。其中1 638例患者年龄≤45岁。根据复旦大学附属肿瘤医院行根治性宫颈切除术的标准,653例(39.87%)患者初步符合行ART的FIGO分期、肿瘤大小和病理类型的标准,但其中49例患者最终因肿瘤播散而放弃保留生育功能的手术。本研究最终确定604例(36.87%)患者可能适合接受ART手术。结论:在年龄≤45岁的宫颈癌患者中,有一定比例的人群符合ART的指征。对这部分患者,如能在术前充分告知患者手术的风险和获益,将有可能接受ART,在治疗肿瘤的同时保留生育功能。     

The relationship between positive peritoneal cytology and the prognosis of patients with FIGO stage I/II uterine cervical cancer

Objective

The purpose of this study was to assess whether peritoneal cytology has prognostic significance in uterine cervical cancer.

Methods

Peritoneal cytology was obtained in 228 patients with carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics [FIGO] stages IB1-IIB) between October 2002 and August 2010. All patients were negative for intraperitoneal disease at the time of their radical hysterectomy. The pathological features and clinical prognosis of cases of positive peritoneal cytology were examined retrospectively.

Results

Peritoneal cytology was positive in 9 patients (3.9%). Of these patients, 3/139 (2.2%) had squamous cell carcinoma and 6/89 (6.7%) had adenocarcinoma or adenosquamous carcinoma. One of the 3 patients with squamous cell carcinoma who had positive cytology had a recurrence at the vaginal stump 21 months after radical hysterectomy. All of the 6 patients with adenocarcinoma or adenosquamous carcinoma had disease recurrence during the follow-up period: 3 with peritoneal dissemination and 2 with lymph node metastases. There were significant differences in recurrence-free survival and overall survival between the peritoneal cytology-negative and cytology-positive groups (log-rank p<0.001). Multivariate analysis of prognosis in cervical cancer revealed that peritoneal cytology (p=0.029) and histological type (p=0.004) were independent prognostic factors.

Conclusion

Positive peritoneal cytology may be associated with a poor prognosis in adenocarcinoma or adenosquamous carcinoma of the uterine cervix. Therefore, the results of peritoneal cytology must be considered in postoperative treatment planning.     

Advances in fertility-sparing surgery for cervical cancer

This article reviews the literature on fertility-sparing surgery in early cervical cancer. The article evaluates selection criteria, preoperative management and the most frequent surgical procedures used for preservation of fertility in cervical cancer. The article also analyzes oncological, fertility and pregnancy results. Oncological outcomes are not statistically different among single groups (vaginal radical trachelectomy, abdominal radical trachelectomy, simple trachelectomy or cone with or without neoadjuvant chemotherapy). Oncological results after fertility-sparing procedures in women with tumors smaller than 2 cm are comparable with women with the same risk factors after radical hysterectomy. Pregnancy following fertility-sparing surgery is associated with a variety of adverse pregnancy outcomes, especially second-trimester loss and preterm delivery. Less radical procedures (simple trachelectomy or cone with or without neoadjuvant chemotherapy) show statistically significant better pregnancy results. The pregnancy rate after abdominal radical trachelectomy was dramatically lower than in women treated with other types of fertility-sparing surgery. In the future, it will be necessary to optimize the technique and management of fertility-sparing surgery in order to attain good oncological results. Pregnancy outcomes should be given high priority. Fertility-sparing surgery is valuable for women who want to preserve their reproductive capability.     

Prevalence and characteristics of late postoperative voiding dysfunction in early-stage cervical cancer patients treated with radical hysterectomy.

BACKGROUND: Although effective as a primary treatment for early-stage cervical cancer, radical hysterectomy is associated with significant long-term morbidities, most commonly, voiding dysfunction. OBJECTIVE: To examine prevalence and characteristics of voiding dysfunction following radical hysterectomy for early-stage cervical cancer. METHODS: One hundred-eighty seven patients with FIGO stage IA2-IIA cervical cancer who underwent class II-III radical hysterectomy with systematic pelvic lymphadenectomy between January 1, 2002 and June 31, 2005 were interviewed with questionnaire on voiding function. Medical records were also reviewed for operative and pathologic data. RESULTS: The prevalence of symptomatic bladder dysfunction was 25.1%. There was no statistically significant association between rates of bladder dysfunction and all examined clinical/operative factors. The most common pattern of bladder dysfunction were incomplete emptying in 25 (13.4%) and urgency and nocturia in 21 (11.2%) each. CONCLUSION: Voiding dysfunction is a common and clinically significant long-term complication following radical hysterectomy. The pattern of dysfunction reflects combined surgical disruption of both parasympathetic and sympathetic innervations of the pelvis.     

早期宫颈癌(Ⅰb-Ⅱa期)预后相关因素的回顾性分析

Objective: To estimate the impact of parametrial infiltration and lymph node metastasis on clinical outcome in women with early-stage cervical cancer following radical hysterectomy and pelvic lymphadenectomy. Methods: Clinical records and pathologic slides of 532 patients with early-stage cervical cancer (330 Ib and 202 IIa) treated with radical hyster- ectomy and pelvic lymphadenectomy were reviewed. The study group comprised 520 patients with squamous cell carcinoma and 12 patients with adenocarcinoma of the cervix. Median follow-up time was 67 months. The association among the various histopathologic predictors of outcome was determined with analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model. Results: FIGO stage, histologic type, tumor size, depth of invasion, parametrial infiltration, lymph node metastasis, and remote metastasis were identified as significantly biologically relevant and therefore were included as candidate predictors in multivariate analysis. In particular, parametrial infiltration and lymph node metastasis were found to be simultaneous predictors of death on multivariate analysis (P < 0.05). After controlling for these two factors, the other variables considered were not statistically significant up to a two-way interaction. Conclusion: Presence of parametrial infiltration and/or lymph node metastasis in women with early-stage cervical cancer is an independent poor prognostic factor. In addition, the relatively poor survival of women with more than one lymph nodes identified with cancer cells.     

早期子宫颈癌保留生育功能手术的研究进展

早期子宫颈癌保留生育功能手术的开展是妇科恶性肿瘤治疗的里程碑之一,其治疗效果逐步得到妇产科医生和患者的肯定,如何更优化的选择及评估患者、提高手术效果、减少并发症、改善肿瘤结局和妊娠结局是目前的热点问题.文章通过对近年国内外治疗的新进展及尚存争议的问题进行综述,以期推动今后的治疗不断向安全、高效、微创的方向发展,在获得临床治愈的前提下更好地改善患者的生活质量.     

Clinical recommendation radical trachelectomy for fertility preservation in patients with early-stage cervical cancer

Radical trachelectomy (RT) is a fertility-sparing procedure with the aim to provide adequate oncological safety to patients with cervical cancer while preserving their fertility. In the current review, indications, development of the procedure, technical aspects, preoperative and postoperative management, and oncological, fertility, and obstetric outcomes are discussed and studied with respect to whether the procedure is performed abdominally or vaginally. Complications of RT, staging, and more conservative alternatives to RT are discussed as well. A systematic MEDLINE search was performed, which yielded 218 articles, of which 75 were selected for further analysis based on the number of patients and the quality of the study. Strict morphologic criteria should be applied to the candidates to maintain oncological safety. When limited to a tumor less than 2 cm in diameter, the overall recurrence rate after vaginal RT is 3% to 6% and the death rate is 2% to 5%. Data on fertility and obstetric outcome are mostly based on the results of patients who underwent vaginal RT. More data are needed to be able to draw the same conclusions for abdominal RT. Fertility seems not to be decreased, but the risk for premature delivery is 2 to 3 times higher compared to women with an intact cervix. In locally advanced cervical tumors with a diameter larger than 2 cm, neoadjuvant chemotherapy followed by RT may be offered after explaining the experimental nature to the patient. In conclusion, RT is an oncologically safe technique in women with early invasive cancer. The rate of term pregnancies still needs improvement. Fertility-preserving treatment of women with tumors larger than 2 cm in diameter can be done by combining neoadjuvant chemotherapy and trachelectomy; however, experience is still limited.     

Risk of ovarian recurrence after ovarian conservation in early-stage cervical cancer treated with radical surgery: A propensity match analysis

IntroductionThe primary aim of the present study was to assess the incidence of ovarian metastasis/recurrence and the survival of patients undergoing radical hysterectomy with ovarian conservation (CONSERV) versus oophorectomy (OOPHOR). Secondary aim was to assess the incidence and the characteristics of menopausal symptoms in both groups.Materials and methodsRetrospective, multi-center, observational cohort study including patients <50 years with clinical FIGO 2009 stage IA1-IB1/IIA1 cervical carcinoma, treated by primary surgical treatment between 02/2007 and 07/2019. One-to-one case–control matching was used to adjust the baseline prognostic characteristics in survival analysis.Results419 patients were included. 264 in the OOPHOR (63.0%) and 155 (37.0%) in the CONSERV group. Ovarian transposition was performed in 28/155 (18.1%) patients. 1/264 (0.4%) patient had ovarian metastasis from endocervical adenocarcinoma. After propensity-matching, 310 patients were included in the survival analysis (155 per group). 5-year disease-free survival of patients undergoing CONSERV versus OOPHOR was 90.6% versus 82.2%, respectively (p = 0.028); 5-year overall survival was 94.3% versus 90.8%, respectively (p = 0.157). Two patients (1.3%) developed recurrence on the conserved ovary. CONSERV represented an independent protective factor of recurrence (HR:0.361, 95%CI 0.169–0.769; p = 0.008). 28 (20.6%) in the CONSERV group versus 116 (60.4%) in the OOPHOR group complained of menopausal symptoms during follow up (p < 0.001). HRT was prescribed to 12.0% of patients (median HRT time was 20 months).ConclusionCONSERV was associated with reduced risk of recurrence and menopausal symptoms in early-stage cervical cancer. As the risk of ovarian metastasis and ovarian recurrence is relatively low, CONSERV in pre-menopausal women has to be considered.     

Outcomes after radical hysterectomy in patients with early-stage adenocarcinoma of uterine cervix

Background:

To determine the prognostic factors and treatment outcomes of patients with early-stage adenocarcinoma (AdCa) of uterine cervix who underwent radical hysterectomy (RH).

Methods:

Patients with early-stage squamous cell carcinoma (SCCa) of the uterine cervix who underwent RH were compared with patients with AdCa by multivariate analysis.

Results:

A total of 1218 patients were eligible, of which 996 (81.8%) had SCCa and 222 (18.2%) had AdCa. In multivariate analysis, parametrial involvement and lymph node metastasis were significant factors for both recurrence-free survival(RFS) and overall survival (OS) of patients with AdCa, whereas age, tumour size, parametrial involvement and lymph node metastasis were significant factors for both RFS and OS of patients with SCCa. After adjusting for significant prognostic factors, patients with AdCa had significantly poorer RFS (odds ratio (OR)=2.07, 95% confidence interval (CI)=1.37–3.12, P=0.001) and OS (OR=2.56, 95% CI=1.65–3.96, P<0.001) than patients with SCCa. Recurrence outside the pelvis was more frequent in AdCa than in those with SCCa (75 vs 57.8%, P=0.084).

Conclusion(s):

Although RH is still acceptable for treatment of patients with AdCa, a more effective systemic adjuvant therapy is required.