Postoperative Radiotherapy Following Inadvertent Simple Hysterectomy versus Radical Hysterectomy for Cervical Carcinoma

Purpose: For cervical carcinoma, postoperative radiation therapy (PORT) following radical hysterectomy (RH) is indicated for certain adverse pathological factors. Simple hysterectomy (SH) is considered inadequate treatment for invasive cervical carcinoma and PORT is required for all such cases. Clinical outcome of patientsreceiving PORT following SH and RH may be different. The aim of our retrospective study is to compare the results of PORT following inadvertent SH or RH in cervical carcinoma. Materials and
Methods: During year s2003-2005, we treated 83 patients with cervical carcinoma with PORT following either SH (Group SH, 33 patients) or RH (Group RH, 50 patients). All patients were treated with pelvic external beam radiation therapy (EBRT) followed by intravaginal brachytherapy (IVBT). The endpoints of the study were local control, recurrence free survival (RFS) and delayed complications.
Results: Median follow period up was 34 months (range 2-75 months). Local control rate observed in Gp SH and RH was 70% and 88% respectively with a p value of <0.05. Cumulative 5-year overall survival (OS) for combined group was 62%. Group RH patients had significantly better 5-year RFS than Group SH patients (72% and 49% respectively; p value 0.04). The frequency of Grade III-IV toxicity (bladder, rectum, and bowel) in Group SH versus Group RH was 6% vs 8% respectively (p value 0.1). The pedal lymph edema was higher in Group RH patients (10% vs 3%, p value <0.05).
Conclusion: PORT provides greater clinical benefit in patients who had undergone RH than SH for early stage invasive cervical carcinoma.