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) Alvarez et al. (1991) Lee et al. (1989) Kenter et al. (1989) Fuller et al. (1989) Inoue et al. (1984) Volterrani et al. (1983) Boyce et al. (1981) Hoskins et al.(1976) Piver and Chung (1975) Liu and Meigs (1955) Landoni et al. (1997) Barillot et al. (1997) Radiation Therapy Eifel et al. (1994) Perez et al. (1992) Lowrey et al. (1992) Coia et al. (1990) Horiot et al. (1988) Montana et al. (1987) Landoni et al. (1997) 0% 20% 40% 60% 80% 100%

RT vs. RH for FIGO IB – IIA - Pathologic risk factors requiring postop RT Landoni et al. Lancet 350:535, 1997 1986-1991—468 pts . Stage I–IIA 343 eligible Randomize RH - 172 pts RT - 171 pts 2 protocol violations 4 protocol violations 170 analyzed 167 analyzed

RT vs. RH for FIGO IB – IIA - Pathologic risk factors requiring postop RT Landoni et al. Lancet 350:535, 1997 RT pts (n = 170) ≤4 cm (114) Risk factor >4 cm (55) 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%)

RT vs. RH for FIGO IB – IIA - Complications of treatment Landoni et al. Lancet 350:535, 1997  RH Hydronephrosis   GU, lymphatic Atonic bladder   Overall Other GU  RH + RT SBO   SBO, GU, RH alone Proctitis RH + RT lymphatic Leg edema RT alone  RT alone Lymphocyst   Proctitis 0 5 10 15 20

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

NIH Consensus Development Conference Statement - Cervical Cancer (April, 1996) “Efforts should be made to carefully select patients for treatment in order to ensure that they are treated with RT or surgery, but not both. The combined use of radical surgery followed by radiation substantially increases the cost and morbidity of treatment.”