Analysis of Treatment Failures in Early Uterine Cervical Cancer

Kim, Joo Young; Lee, Kyu Chan; Choi, Myung Sun

Abstract

One hundred and twenty six patients with early uterine cervical cancer who had been treated at department of Radiation Oncology of Korea University Hospital from jan. 1981 to Dec. 1988 were analysed retrospectively by the treatment result and pattern of failures. All patients had stage la to lla disease and were grouped whether they had combination of operation and postop irradiation or radiation therapy alone. 1) Sixty six patients belonged to the combination treatment group and 60 patients to the radiation alone group. 2) Combination group consisted of 18.1%(12/66)stage la, 71.2%(47/66) stage lb and 10.6%(7/66) stage lla patients. There were no stage la, 18.8%(11/60) stage lb and 81.6%(49/60) stage lla patients for RT alone group. 3) There were total 23%(29/126) treatment failures, 13 patients in combination group and 16 patients in RT alone group. In 66 patients of combination group, they were found to have 5 locoregional failures, 7 distant failures and 1 at both sites. In 60 patients of RT alone group, 9 locoreginal failure and 7 distant failures occurred. Eighty six percent(25/29) of total failures appeared within 18 month after completion of treatment. About 60% of the patients with regional recurrences which were located at pelvic side wall or pelvic lymph nodes paesented their recurrent disease after 1 year of completion of treatment, whereas same percent of distant failures appeared within 6 month. 4) In RT alone group, the first sites of distant failure were mostly para-aortic lymph node and/o left supraclavicular lymph node(71.4%, 5/7). In combination group, various sites such as inguinal lymph node, mediastinal lymph node, liver, lung and bone appeared first or at the same time with para-aortic and supraclavicular lymph node metastasis. 5) Logistic regression analysis was done for multivariate analysis of the factors contributing to locoregional and distant failures. In combination group, adequacy of the resection margin and the presence of positive pelvic node were found to be the most significant factors(p=0.0423 & 0.0060 respectively). 6) In RT alone group, less than complete regression of the tumor at the end of treatment was the only significant contributing factor for the treatment failures (p=0.0013) with good likelihood ratio.