THE EFFECTS OF POSTOPERATIVE RADIOTHERAPY ON SURVIVAL, COMPLICATIONS AND PROGNOSTIC FACTORS IN STAGE IB CERVICAL CANCER

Between the dates of January 1987 and December 1992, 96 patients were treated with postoperative radiotherapy among the cases who were evaluated and operated as clinical Stage IB carcinomas of the uterine cervix and the results were analysed on June 1994. Thirteen cases had undergone total abdominal hysterectomy and bilateral salpingo-oopherectomy, 41 cases had modified radical hysterectomy and 42 had radical hysterectomy. 50.4-54 Gy external pelvic irradiation without midline shielding and 20 Gy intracavitary (2x10 Gy of vaginal surface dose) irradiation were applied. Five years Overall and disease free survival rates were 82.9% and 77.4% respectively. There was no difference in survival rates due to the type of operation (P=0.920). Factors that significantly affected the 5 years disease free survivals by univariate analysis were lymph node metastasis (positive: 54.7 %, negative: 84.8 %; P<0.001), tumor volume (>4 cm: 63.4 %, <4 cm: 83.5 %; P=0.004), surgical margins (positive: 62.1 %, negative: 83.1 %; P=0.029), deep stromal invasion (positive: 71.1%, negative: 92.6%, P=0.056) and histopathologic type (P=0.036). In multivariate analysis lymph node metastasis was the only independent prognostic factor (P=0.008). The complication rates of Grade II (7.4%) and Grade III (5.1%) indicates that postoperative radiotherapy was tolerated well by the patients. The efficiency of postoperative radiotherapy in clinically Staged IB cervix carcinomas with inadequate surgery or with poor prognostic criteria was discussed and concluded that it might have positive contribution to survival with an acceptable complication rate.