Objective: To assess the benefit of adjuvant radiotherapy after radical hysterectomy in node negative FIGO stage IB-IIA cervical cancer patients with intermediate risk factors.
Material and Method: Medical records of FIGO stage IB-IIA cervical cancer patients who underwent radical hysterectomy at Rajavithi Hospital between January 2000 and December 2007 with negative pelvic node were reviewed. Of the 573 nodenegative stage IB-IIA cervical cancer patients, 115 had at least one of the intermediate risk factors; 18 cases received adjuvant radiotherapy (RT group) while 97 patients did not receive (non RT group). Recurrence-free survival and complications of combined treatment of each group were investigated.
Results: The median follow-up period was 62.5 months (range 5-119 months). Of the 115 patients with any of the intermediate risk factors, 56 (48.7%) had single intermediate risk factor and 59 (51.3%) had two or more intermediate risk factors. Sixteen patients (13.9%) developed recurrence, 6 at the locoregional site, 5 at the distant sites and 5 at synchronous sites. Eleven patients (18.6%) who had two or more intermediate risk factors developed recurrences. In the RT group, 3 patients (20.0%) developed recurrences whereas 8 patients (18.2%) in the non RT group developed recurrences (p = 0.574). The 5-year recurrence free survival rates in patients with two or more risk factors received adjuvant radiotherapy and those without adjuvant radiotherapy were 77.8% and 83.0%, respectively (p = 0.904). No locoregional recurrence occurred in patients who received adjuvant radiotherapy. Three patients had treatment related complications (2 with leg lymphedema and 1 with radiation proctitis).
Conclusion: Postoperative radiotherapy in node-negative stage IB-IIA cervical cancer patients with intermediate risk factors reduced only the incidence of locoregional recurrence. Distant recurrence was the major pattern of treatment failure after adjuvant radiotherapy.

Keywords: Cervical cancer, Radical hysterectomy, Negative lymph node, Intermediate risks, Adjuvant radiotherapy