To identify significant prognostic factors and sites of treatment failure in patients undergoing simple hysterectomy in the presence of invasive cervical cancer, the records of 122 women referred following such a procedure were reviewed retrospectively. All but 2 patients received postoperative megavoltage irradiation. Patients with and without gross disease at the start of posthysterectomy treatment had 5-year survival rates of 39 and 75%, respectively. Factors found to be significantly related to survival were the presence of gross disease (P = 0.0001), retrospectively determined tumor stage (P = 0.0001), and lymphangiogram status (P = 0.007). Patients with adenocarcinoma did not fare worse than those with squamous carcinoma (P = 0.6). By multivariate analysis, factors emerging as significantly detrimental to survival were the presence of gross disease (P = 0.0001) and aortic adenopathy on lymphangiogram (P = 0.004). The most common site of treatment failure was the pelvis. The radiotherapy complication rate was 18%; 7% of patients experienced major morbidity. While survival for patients with no residual cancer after simple hysterectomy is favorable, the treatment complication rate may be higher than that reported for patients undergoing primary irradiation. Survival for patients with gross disease at the start of posthysterectomy treatment is poor.