Introduction/Background Lymphovascular space invasion (LVSI), deep stromal invasion (DSI) and large tumor size have been identified as predictors for intermediate risk for recurrence. Adjuvant radiotherapy (RT) has been advocated in these patients (Sedlis Gynecol Oncol 1999,73:177). However, it is still controversial whether adjuvant radiochemotherapy (RCT) improves overall survival (OS).
Methodology All consecutive patients (1997–2017) with cervical cancer FIGO (2009) stage IB1 (≤ 4cm) treated in our department were included. Intermediate risk for recurrence was defined as presence of two of the following factors in patients with negative lymph nodes: LVSI, DSI (>10 mm) and large tumor size (>2cm).
Results Two hundred-and-one patients were included into the study, of which 186 patients underwent primary surgery and 15 patients received a fertility sparing treatment (table 1). Mean time of follow-up was 11 years (IQR 6–15). Postoperatively, 24 patients received adjuvant therapy due to presence of positive lymph nodes, positive section margins or vaginal intra-epithelial neoplasia: RCT (n=16), RT (n=7) or chemotherapy (n=1). None of the patients with intermediate risk factors according underwent adjuvant RT/RCT. Disease recurrence was observed in 23 patients (11%). The recurrences were local (n=14), distant (n=2) or both local and distant (n=7). Ten patients died of disease. The 5-year OS was 93% and the 5-year progression-free-survival (PFS) was 89%. Cox proportional hazards models showed that intermediate risk factors did not significantly influence OS or PFS.
Conclusion Recurrence rate was rather low (11%), despite the fact that only 12% of the patients with cervix cancer stage IB1 received postoperative radio(chemo)therapy. Intermediate risk factors such as LVSI, DSI (>10 mm) or tumor size >2 cm did not predict recurrence nor survival. Future studies are needed to elucidate whether adjuvant radiotherapy is needed in the current era with better survival than in the nineties when the GOG99 (Sedlis et al.) was performed.
Disclosure Nothing to disclose.
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