Evaluation of clinical and pathologic risk factors may reduce the rate of multimodality treatment of early cervical cancer

Ofer Gemer, Ofer Lavie, Michael Gdalevich, Ram Eitan, Ela Mamanov, Benjamin Piura, Alex Rabinovich, Hanoch Levavi, Bozhena Saar-Ryss, Reuvit Halperin, Shachar Finci, Uzi Beller, Ilan Bruchim, Tally Levy, Amichay Meirovitz, Inbar Ben Shachar, Alon Ben Arie

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: To assess the rate of postoperative adjuvant treatment in patients who underwent radical hysterectomy for early cervical cancer and to suggest criteria for the triage of patients who have a high probability of multimodality treatment. Methods: This was a multicenter retrospective study of 514 patients with FIGO stages IA2-IIA cervical cancer who underwent radical hysterectomy between 1999 and 2010. The patients were divided into 2 groups according to whether or not postoperative radiation was administered. The 2 groups were compared with regard to clinical and histopathologic variables divided into major and minor criteria (intermediate risk factors) based on lymph nodes status, parametrial involvement, tumor size, deep stromal invasion, and lymph-vascular space invasion. Results: We identified 294 (57.2%) patients who received adjuvant postoperative radiotherapy (RT) or chemoradiation. Fifty-three percent of these patients who were treated by adjuvant radiation had only intermediate risk factors. Combining the various combinations of 2 out of 3 of the following criteria, we found that 89% of patients with tumors ≥2 cm and lymph-vascular space invasion received RT, 76% of patients with tumors ≥2 cm and depth of invasion >10mm received RT, and 87% of patients with tumors depth of invasion >10mm and lymph-vascular space invasion received RT. Conclusions: This study suggests that in patients with early cervical cancer, clinicopathologic evaluation of tumor size and lymph-vascular space invasion should be undertaken before performing radical hysterectomy. This approach can serve to tailor treatment, reducing the rate of employing both radical hysterectomy and chemoradiation.

Original languageEnglish
Pages (from-to)37-42
Number of pages6
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Issue number1
StatePublished - Feb 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2013 Wolters Kluwer Health, Inc. All rights reserved.


  • Cervix cancer
  • Early stage
  • LVSI
  • Radiation
  • Radical hysterectomy


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