Journal of Clinical Oncology, Vol 3, 912-916, Copyright © 1985 by American Society of Clinical Oncology
A pilot study of adjuvant therapy in patients with cervical cancer at high risk of recurrence after radical hysterectomy and pelvic lymphadenectomy
MS Wertheim, TB Hakes, AN Daghestani, D Nori, DH Smith and JL Lewis Jr
The prognosis after surgical therapy (radical hysterectomy and pelvic
lymphadenectomy) of stages IB and IIA carcinoma of the cervix is affected
by several histopathologic findings within the resected specimen. Patients
at high risk of recurrence include those with involved pelvic lymph nodes,
lymphatic or vascular invasion in the cervix, tumor size greater than 4 cm,
grade 3 lesions, adenosquamous histology, parametrial invasion, and
evidence of locally metastatic (noncontiguous) disease. We report the
results of adjuvant chemotherapy (cisplatin and bleomycin) and pelvic
radiotherapy in 32 patients with cervix cancer deemed to be at high risk of
recurrence after radical hysterectomy and pelvic lymphadenectomy. The
continuous disease-free survival rate for the 32 evaluable patients in 84%
at a mean and median follow-up time of 28 months. Three patients are dead
of disease and two patients are alive after treatment of local recurrences
giving a survival rate of 91%. The two patients who are alive after disease
recurrence demonstrated only locally recurrent disease while the three
patients who have died with recurrent disease relapsed both locally and
systemically. Complications of this treatment program were not
significantly greater than those observed in prior studies using the
combination of surgery and adjuvant radiotherapy without chemotherapy. When
compared with the results from historical controls in a large series of
similar patients at the same institution, the results in this pilot study
are encouraging and would seem to justify a randomized prospective clinical
trial.
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