Adjuvant Postoperative Pelvic Radiation for Carcinoma of the Uterine Cervix: Pattern of Cancer Recurrence in Patients Undergoing Elective Radiation following Radical Hysterectomy and Pelvic Lymphadenectomy

Thirty-seven patients with invasive cervical cancer have been referred to the Department of Radiation Oncology at the University of Washington following radical hysterectomy and pelvic hysterectomy and pelvic lymphadenectomy.Patients were retrospectively staged according to the current classification of the International Federation of Gynecology and Obstetrics. Thirty-five patients were initially clinical stage IB, and two patients were initially clinical stage HA. Operative and pathology reports were reviewed. Technical parameters of radiation therapy as well as portal verification films were reviewed in all patients developing recurrence. Pattern of involvement was scored at the time of documentation of initial cancer recurrence, and correlated with pathologic risk factors, radiation dose, and target volume. Follow-up ranged from 15 to 159 months. The median duration of observation is 45 months, and the mean duration of follow-up is 49 months in patients who have not manifested recurrence.Thirty-two patients had squamous cell carcinomas, of whom three represented examples of the “glassy-cell” variant. Five patients had primary adenocarcinomas of the cervix. The major indications for postoperative radiation are diagramed in Figure 1.Twenty-seven patients received their postoperative radiation therapy at University Hospital in Seattle. Ten patients were referred to radiation facilities in the State of Washington, which would permit them to undergo treatment closer to their homes. Radiation treatments were administered employing either parallel opposed anterior and posterior portals, or a four-field “box” technique. All patients received teletherapy to the full pelvis with a mini-