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Purpose: To explore the reasons of hysterectomy and indications of post-hysterectomy radiotherapy in carcinoma cervix cases.  Methods: From January 2013 to May 2015, medical records of 64 cases of carcinoma cervix (post-hysterectomy) who were referred for radiotherapy to our hospital were analyzed retrospectively.  Results: Medical records of 64 cases were reviewed. The median age was 47 years. In 45% of females hysterectomy was done in towns, but in majority of cases (55%) hysterectomy was done in different cities of Rajasthan. Simple hysterectomy was done in 31 of (48%) cases. Wertheim’s hysterectomy was done in remaining 33 cases (52%). 15 cases (23%) were treated by IMRT technique, while remaining 87% cases were treated by 3DCRT technique to dose of 50 Gy in 25 fractions followed by CVS brachytherapy. All cases also received concurrent chemotherapy. Reason for hysterectomy was analyzed. In 32 (50%) cases, biopsy from gross lesion at cervix or PAP smear test was not done before surgery. In 32 cases (50%) understaging of the tumor or inadequate staging before hysterectomy was performed. Histopathology report analysis revealed that in 9 cases (14%) primary tumor size was less than 4 cm, in 27 cases (64%) there was no comment on pT size, in 22% cases primary tumor was larger than 4 cm. Surprisingly in one case the pT size was 7 cm. LVSI was not seen in 18 cases (28%), positive in 20 case (31%) and with no comment in 26 cases. More than 50% of stroma thickness was involved in 54 cases (84%), and in remaining 10 cases there was no comment on stroma invasion. In 33 cases (52%) pelvic lymphadenectomy was done, in 48% cases lymph nodes were not addressed in surgery. In 36 cases (56%) pelvic lymph node metastasis was seen either in preoperative imaging (USG/CT scan) or in histopathology. Median follow-up duration was 6 months. Locoregional failure was seen in 10 cases (16%), 6 cases (9%) also developed distant metastasis.  Conclusion: Failure to perform biopsy from gross lesion at or under staging/inadequate staging before surgery was the main reasons for inappropriate hysterectomy for carcinoma cervix. Inappropriate hysterectomy followed by chemo-radiotherapy resulted in poor tumor control rate as in our study, 1 out of every 4 patients failed loco-regionally with median follow up of 6 months. Strict adherence to guidelines for cervical cancer diagnosis and treatment is advised to prevent inappropriate hysterectomy.

Radiotherapy after hysterectomy in carcinoma cervix: Audit from a tertiary care cancer hospital in India’s largest state “Rajasthan”