Objective:

To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy.

Design:

A retrospective analysis of prognostic factors.

Location:

Hospital A.C.Camargo, Sao Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre.

Patients:

A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied.

Criteria for inclusion in the study were:

confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C.Camargo itself). At the end of the follow-up period, 410 patients (65 per cent) had no evidence of disease and 219 (34.8 per cent) had died because of the tumor.

Intervention:

The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982.

Main outcomes measures:

Multivariate analysis of the different variables was performed according to the Cox regression method.

Results:

The variables of prognostic value were, in decreasing order of importance: the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575).

Conclusion:

Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.