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| |  SGO CONFERENCE: Radiotherapy Helps Prevent Cervical Cancer Recurrence ORLANDO, FL -- February 9, 1998 -- Women will decrease their chances for a recurrence of cervical cancer and possible death after a radical hysterectomy and pelvic lymphadenectomy (excision of lymph nodes from the pelvic area), if they receive supplemental radiotherapy. This is the conclusion of a seven-year prospective and randomised study designed to evaluate the risks and benefits of radiotherapy aimed at reducing recurrence of cervical cancer and mortality. This new medical research was conducted by the Gynecologic Oncology Group, representing 45 academic institutions and medical centres. Alexander Sedlis, MD, professor in the department of obstetrics and gynecology, State University of New York Downstate Medical Center, Brooklyn, N.Y., presented the results today at the 29th annual meeting of the Society of Gynecologic Oncologists (SGO), Orlando, FL. A large-size tumour, deep stromal penetration (invasion into underlying tissue) and capillary space involvement increase the risk of cancer recurrence and death in women with stage 1B cervical cancer who are treated only with a radical hysterectomy and excision of lymph nodes from the pelvic area, the researchers write. These conditions, known clinically as large tumour diameter (LTD), deep stromal penetration (DSP) and capillary lymphatic spaces (CLS), have all recently been recognised as risk factors due to their documented association with increased cancer recurrence and mortality. In fact, previous studies conducted by the Gynecologic Oncology Group revealed that the presence of these risk factors can increase the probability of cancer recurrence by 69 percent. Women with lymph node metastases have traditionally been treated with radiotherapy. This post-operative treatment was found to reduce pelvic recurrence rate but had no impact on survival. As an extension of this, a supposition was made that for patients with other high risk factors for recurrence, adjuvant (or supplemental) radiotherapy would also be beneficial. For the study, 277 patients were recruited from participating institutions if they had at least two of the following risk factors: greater than one-third stromal invasion, CLS and large tumour diameter. They were randomly assigned to two groups, radiotherapy (Rt) or no further treatment (NFT). The distribution of age, race, performance status, cell type, tumour size and stromal penetration was balanced between the two groups. However, there was a significantly higher number of patients with CLS who received no further treatment which was compensated for by the large number of women with larger tumour size and deeper penetration receiving Rt. Of the patients receiving radiotherapy, 88 percent received the prescribed dose of radiation therapy. Patients were evaluated by physical examination, blood counts, blood chemistries and chest x-rays, every three months for the first two years of follow-up and every six months during the subsequent years. Renal sonogram, IVP or CT scans with contrast were performed at six months and then yearly. Of the 277 eligible patients, 137 were randomly assigned to radiotherapy and 140 to no further treatment. Key findings included: -- Cancer recurred in 60 of the patients from the entire study group; 39 of the recurrences were among the NFT group, 21 among those receiving treatment. When adjusting for all risk factors, the recurrence rate was reduced by 44 percent in patients receiving radiotherapy. -- Thirty of the NFT group are now deceased, 25 from cancer, where as in the Rt group, there were only 18 deaths, with 15 from cancer. This means there was a 36 percent decrease in mortality among patients receiving radiotherapy treatment. -- Sixty-eight patients in the treatment group had adverse effects and complications because of the radiotherapy. The study's results strongly indicate that these women with cervical cancer and these risk factors should be treated with postoperative radiotherapy following their radical hysterectomy and lymph node dissection.
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