Results of Hyperfractionated Radiation Therapy in Bulky Stage Ib, IIa, and IIb Uterine Cervical Cancer

Kim, Jin Hee; Kim, Ok Bae

Abstract

PURPOSE
To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb.
METHODS
AND MATERIAl: Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University, School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO staging system, there were stage Ib (3 patients), IIa (6 patients) with exophytic (> or = 5cm in diameter) and huge endophytic mass, and IIb (32 patients) with median age of 55 years old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield (4x10cm), and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively.
RESULTS
Five year local control rate was 78% and the actuarial overall five year survival rate was 66.1% for all patients, 44.4% for stage Ib, IIa and 71.4% for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five year survival rate was 88.9%, 73% respectively. Pelvic lymph node status (negative : 74%, positive:25%, P= 0.0015) was significant prognostic factor affecting to five year survival rate. There was marginally significant survival difference by total dose to A point (>84Gy : 70%, <84Gy : 42.8%, P=0.1). We consider that the difference of total dose to A point by stage (mean Ib,IIa : 79Gy, IIb : 89Gy P=0.001) is one of the causes in worse local control and survival of Ib,IIa than IIb.The overall recurrence rate was 39% (16/41). The rates of local failure alone, distant failure alone, and combined local and distant failure were 9.7%, 19.5%, and 9.7%, respectively. Two patients developed leukopenia (>; or =grade 3) and Three patients developed grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted.
CONCLUSION
We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophytic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.