Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

ABSTRACT

Objective: To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy. Design: A retrospective analysis of prognostic factors. Location Hospital A.C.Camargo, Sao Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre. Patients A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied. Criteria for inclusion in the study were confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C.Camargo itself). At the end of the follow-up period, 410 patients (65 per cent) had no evidence of disease and 219 (34.8 per cent) had died because of the tumor. Intervention The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982. Main outcomes measures: Multivariate analysis of the different variables was performed according to the Cox regression method. Results: The variables of prognostic value were, in decreasing order of importance the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575). Conclusion: Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.