Rethinking the use of radiation and chemotherapy after radical hysterectomy: A clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial

Bradley J. Monk, Jianmin Wang, Samuel Im, Richard J. Stock, William A. Peters, P. Y. Liu, Rolland J. Barrett, Jonathan S. Berek, Luis Souhami, Perry W. Grigsby, William Gordon, David S Alberts

Research output: Contribution to journalArticle

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Abstract

Objective. To retrospectively analyze data from a previously reported randomized trial of either pelvic radiation (RT) or RT + chemotherapy (CT) in patients undergoing radical hysterectomy and pelvic lymphadenectomy with positive pelvic lymph nodes, parametrial involvement, or surgical margins; to explore associations between RT + CT; and to investigate histopathologic and clinical factors which might be predictive of recurrence. Methods. Histopathologic sections from biopsies and hysterectomies and clinical data were reviewed from patients with stage IA2, IB, or IIA cervical cancer treated with RT or RT + CT (cisplatin 70 mg/m2 plus fluorouracil 1000 mg/m 2 every 3 weeks for four cycles). A univariate analysis was performed because the relatively small sample size limited the interpretation of a multivariate analysis. Results. Of the 268 enrolled women, 243 (RT = 116; RT + CT = 127) were evaluable. The beneficial effect of adjuvant CT was not strongly associated with patient age, histological type, or tumor grade. The prognostic significance of histological type, tumor size, number of positive nodes, and parametrial extension in the RT group was less apparent when CT was added. The absolute improvement in 5-year survival for adjuvant CT in patients with tumors ≤2 cm was only 5% (77% versus 82%), while for those with tumors >2 cm it was 19% (58% versus 77%). Similarly, the absolute 5-year survival benefit was less evident among patients with one nodal metastasis (79% versus 83%) than when at least two nodes were positive (55% versus 75%). Conclusions. In this exploratory, hypothesis-generating analysis, adding CT to RT after radical hysterectomy, appears to provide a smaller absolute benefit when only one node is positive or when the tumor size is < 2 cm. Further study of the role of CT after radical hysterectomy in patients with a low risk of recurrence may be warranted.

Original languageEnglish (US)
Pages (from-to)721-728
Number of pages8
JournalGynecologic Oncology
Volume96
Issue number3
DOIs
StatePublished - Mar 2005

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Radiation Oncology
Group Psychotherapy
Hysterectomy
Radiotherapy
Radiation
Drug Therapy
Neoplasms
Adjuvant Chemotherapy
Recurrence
Survival
Lymph Node Excision
Fluorouracil
Uterine Cervical Neoplasms
Sample Size
Cisplatin
Multivariate Analysis
Lymph Nodes
Neoplasm Metastasis
Biopsy

Keywords

  • Cisplatin
  • Radiation
  • Radical hysterectomy
  • Radiosensitization

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Rethinking the use of radiation and chemotherapy after radical hysterectomy : A clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. / Monk, Bradley J.; Wang, Jianmin; Im, Samuel; Stock, Richard J.; Peters, William A.; Liu, P. Y.; Barrett, Rolland J.; Berek, Jonathan S.; Souhami, Luis; Grigsby, Perry W.; Gordon, William; Alberts, David S.

In: Gynecologic Oncology, Vol. 96, No. 3, 03.2005, p. 721-728.

Research output: Contribution to journalArticle

Monk, Bradley J. ; Wang, Jianmin ; Im, Samuel ; Stock, Richard J. ; Peters, William A. ; Liu, P. Y. ; Barrett, Rolland J. ; Berek, Jonathan S. ; Souhami, Luis ; Grigsby, Perry W. ; Gordon, William ; Alberts, David S. / Rethinking the use of radiation and chemotherapy after radical hysterectomy : A clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. In: Gynecologic Oncology. 2005 ; Vol. 96, No. 3. pp. 721-728.
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abstract = "Objective. To retrospectively analyze data from a previously reported randomized trial of either pelvic radiation (RT) or RT + chemotherapy (CT) in patients undergoing radical hysterectomy and pelvic lymphadenectomy with positive pelvic lymph nodes, parametrial involvement, or surgical margins; to explore associations between RT + CT; and to investigate histopathologic and clinical factors which might be predictive of recurrence. Methods. Histopathologic sections from biopsies and hysterectomies and clinical data were reviewed from patients with stage IA2, IB, or IIA cervical cancer treated with RT or RT + CT (cisplatin 70 mg/m2 plus fluorouracil 1000 mg/m 2 every 3 weeks for four cycles). A univariate analysis was performed because the relatively small sample size limited the interpretation of a multivariate analysis. Results. Of the 268 enrolled women, 243 (RT = 116; RT + CT = 127) were evaluable. The beneficial effect of adjuvant CT was not strongly associated with patient age, histological type, or tumor grade. The prognostic significance of histological type, tumor size, number of positive nodes, and parametrial extension in the RT group was less apparent when CT was added. The absolute improvement in 5-year survival for adjuvant CT in patients with tumors ≤2 cm was only 5{\%} (77{\%} versus 82{\%}), while for those with tumors >2 cm it was 19{\%} (58{\%} versus 77{\%}). Similarly, the absolute 5-year survival benefit was less evident among patients with one nodal metastasis (79{\%} versus 83{\%}) than when at least two nodes were positive (55{\%} versus 75{\%}). Conclusions. In this exploratory, hypothesis-generating analysis, adding CT to RT after radical hysterectomy, appears to provide a smaller absolute benefit when only one node is positive or when the tumor size is < 2 cm. Further study of the role of CT after radical hysterectomy in patients with a low risk of recurrence may be warranted.",
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T1 - Rethinking the use of radiation and chemotherapy after radical hysterectomy

T2 - A clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial

AU - Monk, Bradley J.

AU - Wang, Jianmin

AU - Im, Samuel

AU - Stock, Richard J.

AU - Peters, William A.

AU - Liu, P. Y.

AU - Barrett, Rolland J.

AU - Berek, Jonathan S.

AU - Souhami, Luis

AU - Grigsby, Perry W.

AU - Gordon, William

AU - Alberts, David S

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N2 - Objective. To retrospectively analyze data from a previously reported randomized trial of either pelvic radiation (RT) or RT + chemotherapy (CT) in patients undergoing radical hysterectomy and pelvic lymphadenectomy with positive pelvic lymph nodes, parametrial involvement, or surgical margins; to explore associations between RT + CT; and to investigate histopathologic and clinical factors which might be predictive of recurrence. Methods. Histopathologic sections from biopsies and hysterectomies and clinical data were reviewed from patients with stage IA2, IB, or IIA cervical cancer treated with RT or RT + CT (cisplatin 70 mg/m2 plus fluorouracil 1000 mg/m 2 every 3 weeks for four cycles). A univariate analysis was performed because the relatively small sample size limited the interpretation of a multivariate analysis. Results. Of the 268 enrolled women, 243 (RT = 116; RT + CT = 127) were evaluable. The beneficial effect of adjuvant CT was not strongly associated with patient age, histological type, or tumor grade. The prognostic significance of histological type, tumor size, number of positive nodes, and parametrial extension in the RT group was less apparent when CT was added. The absolute improvement in 5-year survival for adjuvant CT in patients with tumors ≤2 cm was only 5% (77% versus 82%), while for those with tumors >2 cm it was 19% (58% versus 77%). Similarly, the absolute 5-year survival benefit was less evident among patients with one nodal metastasis (79% versus 83%) than when at least two nodes were positive (55% versus 75%). Conclusions. In this exploratory, hypothesis-generating analysis, adding CT to RT after radical hysterectomy, appears to provide a smaller absolute benefit when only one node is positive or when the tumor size is < 2 cm. Further study of the role of CT after radical hysterectomy in patients with a low risk of recurrence may be warranted.

AB - Objective. To retrospectively analyze data from a previously reported randomized trial of either pelvic radiation (RT) or RT + chemotherapy (CT) in patients undergoing radical hysterectomy and pelvic lymphadenectomy with positive pelvic lymph nodes, parametrial involvement, or surgical margins; to explore associations between RT + CT; and to investigate histopathologic and clinical factors which might be predictive of recurrence. Methods. Histopathologic sections from biopsies and hysterectomies and clinical data were reviewed from patients with stage IA2, IB, or IIA cervical cancer treated with RT or RT + CT (cisplatin 70 mg/m2 plus fluorouracil 1000 mg/m 2 every 3 weeks for four cycles). A univariate analysis was performed because the relatively small sample size limited the interpretation of a multivariate analysis. Results. Of the 268 enrolled women, 243 (RT = 116; RT + CT = 127) were evaluable. The beneficial effect of adjuvant CT was not strongly associated with patient age, histological type, or tumor grade. The prognostic significance of histological type, tumor size, number of positive nodes, and parametrial extension in the RT group was less apparent when CT was added. The absolute improvement in 5-year survival for adjuvant CT in patients with tumors ≤2 cm was only 5% (77% versus 82%), while for those with tumors >2 cm it was 19% (58% versus 77%). Similarly, the absolute 5-year survival benefit was less evident among patients with one nodal metastasis (79% versus 83%) than when at least two nodes were positive (55% versus 75%). Conclusions. In this exploratory, hypothesis-generating analysis, adding CT to RT after radical hysterectomy, appears to provide a smaller absolute benefit when only one node is positive or when the tumor size is < 2 cm. Further study of the role of CT after radical hysterectomy in patients with a low risk of recurrence may be warranted.

KW - Cisplatin

KW - Radiation

KW - Radical hysterectomy

KW - Radiosensitization

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