Tailoring adjuvant radiotherapy for stage IB–IIA node negative cervical carcinoma after radical hysterectomy and pelvic lymph node dissection using the GOG score

ObjectiveThe use of adjuvant radiotherapy for early stage node negative patients varies for different institutions. The recognized factors such as deep stromal invasion, lymph vascular space invasion, and size of tumor are the most common factors cited for adjuvant radiotherapy. Studies done have shown that this increases local control but may increase chronic toxicity rates. We report on our use of the GOG score to tailor our treatment decisions.MethodsA review of all patients staged IB–IIA who underwent Type 3 Radical Hysterectomy and pelvic lymph node dissection (RH) from 1997 to 2007. The GOG score proposed by Delgado et al. was applied, and patients were stratified into 3 groups; < 40: no adjuvant treatment, 40–120: Small Field RT (SmRT), and > 120: Standard Field RT (StRT)ResultsA total of 126 patients matched these criteria. Sixty one patients underwent either SmRT or StRT. There were only 2 known relapses and one death due to inter current illness. The median follow up was 57 months and the 5 year Disease Free Survival was 98.2%. There were no documented Grade 3 or 4 chronic toxicities. There were significantly less (p = 0.025) patients with lower limb lymphedema in the SmRT group compared to StRT.ConclusionOur study confirms the utility of the GOG score to tailor radiotherapy for this cohort of patients. This has been proven to be high in efficacy and low in morbidity.

► We conduct an analysis of intermediate risk cervical cancer post radical hysterectomy.
► Based on the GOG score, we tailored our fields to target at risk areas while trying to minimize toxicity.
► Excellent disease free survival with a statistically significant reduced lymphedema rate with small field RT.