The Results of Radiation Therapy Alone vs Radiation Plus Chemotherapy of Uterine Cervix Cancer

Lee, Myung Za; Choi, Seog Young; Chun, Hachung

Abstract

PURPOSE: Radiation therapy(RT) is conventionally standard treatment for locally advanced stage for uterine cervix cancer. Recently to improve treatment results, combined chemotherapy and radiation therapy was tried. We retrospectively analysed our experience of 122 patients. Comparision of the results in 45 patients treated with RT alone and 77 patients treated with RT plus chemotherapy was made.
MATERIALS AND METHODS
from January 1985 to December 1991, 122 patients with cervix cancer were treated with whole pelvic external RT and ICR(34 1 ICR, 77 2 ICR, 11 high dose rate ICR) in our department. Forty five patients were treated with RT alone, and 77 patients were treated with combined plus chemotherapy. Mean age was 58 eyars(range:29-81). Histologic types were 111 squamous cell carcinoma, large cell carcinoma, 3 adenocarcinoma, and 2 adenosquamous cell carcinoma. According to the FIGO stage 6 had stage IA94.9%, 11 had IIA(9.0%), 37 had IIB(30.3%), 3 had IIA(2.5%), 63 had IIB(51.6%), and 2 had stage IV(1.6%). In 77 patients with RT plus chemotherapy, 36 patients were treated with VBP(vinblastin, bleoycin, cisplainum), 39 patients with cisplatinum plus 5-FU and 2 patients with 5-FU.
RESULTS
Complete response after external RT(3960cGy-5500cGy)was achieved in 61 patients(50%). He actuarial 5 year and 9 year survival rate was 57.8% and 53.9%, respectively. Five year actuarial survival rate was 63.1% with RT alone(n=45) and 55.9% with RT plus chemotherapy(n=77). Ther 5 year survival rate was 35.5% for 1 course of ICR and 67% for 2 courses of ICR. There was statistically significant advantage of survival with RT alone group who wre treated with 2 coursed of ICR and dose to the A point> or=8000cGy(4/25 died). In RT plus chemotherapy group, dose response was not seen and there was no differnce in 5 year survival between 1 course and 2 course of ICR(50% vs 56.8%), and dose to point A less than 8000cGy and more than 8000 cGy(55.6% vs 55.7%). There was no significant difference in survival between RT alone and RT plus chemotherapy for patients with tumor size greater than 3cm in size. Five year survival rate for early stage (Stage IB and IIA) with RT alone group and with RT plus chemotherapy group was 60% and 77.0%, respectively. In advanced stage (stage IIB, IIIA, IIIB, IVA) the 5 year actuarial survival rate were 62.6%, for RT alone group vs 53.6 for RT plus chemotherapy group.
CONCLUSION
Present study demonstrates that there is no survival advantage with adding chemotherapy in advanced stage of uterine cervix cancer. RT alone is considered as treatment of choice for patients with locally advanced cervix cancer. There was increased survival in RT alone group treated with RT dose above 8000 cGy to point A and 2 course of ICR, but 2 course of ICR and RT dose above 8000 cGy to point A did not affect survival advantage in RT plus chemotherapy group.