A B A N D O N S U R G E R Y A N D P R O C E E D T O S U R G E R Y
Positive lymph nodes at time of hysterectomy A B A N D O N S U R G - - PowerPoint PPT Presentation
Positive lymph nodes at time of hysterectomy A B A N D O N S U R G - - PowerPoint PPT Presentation
Positive lymph nodes at time of hysterectomy A B A N D O N S U R G E R Y A N D P R O C E E D T O S U R G E R Y 5-yr survival rates - Stage IB Landoni et al. (1997) Burghardt et al. (1992) Radical Hysterectomy Hopkins and Morley (1991)
5-yr survival rates - Stage IB
Liu and Meigs (1955) Piver and Chung (1975) Hoskins et al.(1976) Boyce et al. (1981) Volterrani et al. (1983) Inoue et al. (1984) Fuller et al. (1989) Kenter et al. (1989) Lee et al. (1989) Alvarez et al. (1991) Hopkins and Morley (1991) Burghardt et al. (1992) Landoni et al. (1997)
0% 20% 40% 60% 80% 100%
Landoni et al. (1997) Montana et al. (1987) Horiot et al. (1988) Coia et al. (1990) Lowrey et al. (1992) Perez et al. (1992) Eifel et al. (1994) Barillot et al. (1997) Landoni et al. (1997)
Radical Hysterectomy Radiation Therapy
RT vs. RH for FIGO IB–IIA - Pathologic risk factors requiring postop RT
170 analyzed 2 protocol violations
RH - 172 pts
167 analyzed 4 protocol violations
RT - 171 pts
Randomize 343 eligible 1986-1991—468 pts . Stage I–IIA
Landoni et al. Lancet 350:535, 1997
RT vs. RH for FIGO IB–IIA - Pathologic risk factors requiring postop RT
Paracervical involvement 22 (19%) 19 (35%) < 3 mm safe stroma 44 (39%) 25 (45%) Positive margin 7 (6%) 12 (22%) Positive lymph nodes 28 (25%) 17 (31%) ADJUVANT RT 62 (54%) 46 (84%)
Risk factor ≤4 cm (114) >4 cm (55) RT pts (n = 170)
Landoni et al. Lancet 350:535, 1997
RT vs. RH for FIGO IB–IIA - Complications of treatment
5 10 15 20
RH alone RH + RT RT alone
RH
GU, lymphatic Overall
RH + RT
SBO, GU,
lymphatic RT alone
Proctitis
Hydronephrosis Atonic bladder Other GU SBO Proctitis Leg edema Lymphocyst
Landoni et al. Lancet 350:535, 1997
Other costs
Lost work during 4-6 weeks of post-
hysterectomy recovery as well as with radiation therapy
Hysterectomy does not reduce the need for
concurrent chemotherapy or radiation
Overall treatment time –
Radiation alone – 6-8 weeks Surgery + radiation – 9-12 weeks