Results of Radiation Therapy for Carcinoma of the Uterine Cervix

Lee, Kyung Ja

Abstract

PURPOSE: This is a retrospective analysis for pattern of failure, survival rate and prognostic factors of 114 patients with histologically proven invasive cancer of the uterine cervix treated with definitive irradiation.
MATERIALS AND METHODS
One hundred fourteen patients with invasive carcinoma of the cervix were treated with a combination of intracavitary irradiation using Fletcher-Suit applicator and external beam irradiation by 6MV X-ray at the Ewha Womans University Hospital Between March 1982 and May 1990. The median age was 53 years(range : 30-77 years). FIGO stage distribution was 19 for IB, 23 for IIA, 42 for IIB, 12 for IIA and 18 for IIIB. Summation dose of external beam and intracavitary irradiation to point A was 80-90 Gy(median:8580cGy) in early stage(IB-IIA) and 85-00Gy(median:8850cGy) in advanced stage(IIB-IIIB). Kaplan-Meier method was used to estimate the survival rate and multivariate analysis for porgnostic factors was performed using the Log likelihood for Weibull.
RESULTS
The pelvic failure rates by stage were 10.5% for IB, 8.7% for IIA, 23.8% for IIB, 50.0% for IIIA and 38.9% for IIIB. The rate of distant metastasis by stage were 0% for IB, 8.7% for IIA, 4.8% for IIB, 0% for IIIA and 11.1% for IIIB. The time of failure was from 3 to 50 months and with median of 15 months after completion of radiation therapy. There was no significant corelation between dose to point A(< or=90 Gy vs >90 Gy) and pelvic tumor control(p>0.05). Incidence rates of grade 2 rectal and bladder complications were 3.5%(4/114) and 7%(8/114), respectively and 1 patient had sigmoid colon obstruction and 1 patient had sever cystitis. Overall 5-year survival rate was 70.5% and disease-free survival rate was 53.6%. Overall 5-year survival rate by stage was 100% for IB, 76.9% for IIA, 77.6% for IIB 87.5% for IIIA and 69.1% for IIIB. Five-year disease-free survival rate by stage was 81.3% for IB, 67.9% for IIA, 46.8% for IIB, 45.4% for IIIA and 34.4% for IIIB. The prognostic factors for disease-free survival rate by multivariate analysis was performance status(p=0.0063) and response rate after completion of radiation therapy(p=0.0026) but stage, age and radiation dose to point A were not significant.
CONCLUSION
The result of radiation therapy for early stage of the uterine cervix cancer was relatively good but local control rate and survival rate in advanced stage were poor inspite of high dose irradiation to point A above 90 Gy. Prospective randomized studies are recommended to establish optimal tumor doses for various stages and volume of carcinoma f uterine cervix. And ajuvant chemotherapy or radiation-sensitizing agents must be considered to increase the pelvic control and survival rate in advanced cancer of uterine cervix.