Elective postoperative external radiotherapy after hysterectomy in early-stage carcinoma of the cervix. Is additional vaginal cuff irradiation necessary?

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Abstract
This retrospective study of 44 patients who received postoperative radiotherapy soon after hysterectomy for early Stage IB to IIA carcinoma of the cervix was undertaken to determine the need for additional vaginal cuff irradiation (AVCI) following external pelvic irradiation (EPI). The reasons for adjuvant radiotherapy administration were mostly the nonradical type of performed hysterectomy or the presence of adverse prognostic histopathologic features. The overall survival and local control rates were 80% (35/44) and 89% (39/44) at 2 years and 63% (26/41) and 80% (33/41) at 5 years, respectively. Although the 2-year results seemed to indicate that AVCI was necessary, this was not supported by the obtained longer term data. Moreover, it appeared that AVCI could perhaps be safely done after EPI, when occult early-stage cervical carcinoma was found after total abdominal hysterectomy. Data from this study and the literature concerning AVCI's appropriate role in this particular disease condition are discussed.

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