Radical Radiotherapy for Locally Advanced Cancer of Uterine Cervix
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Purpose: This study was performed to evaluate thetreatment results, prognostic factors and complicationrates in patients with locally advanced cancer of uterinecervix after radiotherapy with high-dose rate (HDR)brachytherapy. Materials and Methods: One hundred and twenty patientswith a locally advanced (stages IIB∼IVA accordingto FIGO classification) carcinoma of the uterine cervixwere treated with radiotherapy at the Department ofRadiation Oncology, Samsung Medical Center betweenSeptember 1994 and December 2001. The median age ofthe patients was 61 years (range 29 to 81). Sixty-one, 56and 3 patients had FIGO stage IIB, III, and IV diseases,respectively. All patients were given external beamradiotherapy over the whole pelvis (median 50.4 Gy) andHDR intracavitary brachytherapy, with a median of 4 Gyper fraction, to point A. Twenty-one patients receivedchemotherapy, of which 13 and 21 received neoadjuvantchemotherapy and concurrent chemotherapy, respectively,during the first and fourth weeks of external beamradiotherapy. The chemotherapy was not randomlyassigned and the median follow-up time was 28.5 months(range: 6∼100 months). Results: The three- and 5-year overall survival (OS) anddisease-free survival (DFS) rates were 64.4 and 57.0%, and63.7 and 60.2%, respectively. The 5-year OS and DFS ratesof the patients at stages IIB, III and IV were 60.2, 57.9 and33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariateanalysis indicated that the FIGO stage, overall treatmenttime (OTT) and treatment response were significant variablesfor the OS (p=0.035, p=0.0649 and p=0.0009) andof the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariateanalysis showed that the treatment response was the onlysignificant variable for the OS (p=0.0018) and OTT for theDFS (p=0.0360). The overall incidence of late complicationsin the rectum and bladder were 11.7 and 6.7%,respectively. In addition, insufficiency fractures wereobserved in 7 patients (5.8%). Conclusion: The results of this study suggest that radicalradiotherapy with HDR brachytherapy was appropriatefor the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significantprognostic factors. (Cancer Research and Treatment2004;36:222-227)
Abstract
Purpose: This study was performed to evaluate thetreatment results, prognostic factors and complicationrates in patients with locally advanced cancer of uterinecervix after radiotherapy with high-dose rate (HDR)brachytherapy. Materials and Methods: One hundred and twenty patientswith a locally advanced (stages IIB∼IVA accordingto FIGO classification) carcinoma of the uterine cervixwere treated with radiotherapy at the Department ofRadiation Oncology, Samsung Medical Center betweenSeptember 1994 and December 2001. The median age ofthe patients was 61 years (range 29 to 81). Sixty-one, 56and 3 patients had FIGO stage IIB, III, and IV diseases,respectively. All patients were given external beamradiotherapy over the whole pelvis (median 50.4 Gy) andHDR intracavitary brachytherapy, with a median of 4 Gyper fraction, to point A. Twenty-one patients receivedchemotherapy, of which 13 and 21 received neoadjuvantchemotherapy and concurrent chemotherapy, respectively,during the first and fourth weeks of external beamradiotherapy. The chemotherapy was not randomlyassigned and the median follow-up time was 28.5 months(range: 6∼100 months). Results: The three- and 5-year overall survival (OS) anddisease-free survival (DFS) rates were 64.4 and 57.0%, and63.7 and 60.2%, respectively. The 5-year OS and DFS ratesof the patients at stages IIB, III and IV were 60.2, 57.9 and33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariateanalysis indicated that the FIGO stage, overall treatmenttime (OTT) and treatment response were significant variablesfor the OS (p=0.035, p=0.0649 and p=0.0009) andof the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariateanalysis showed that the treatment response was the onlysignificant variable for the OS (p=0.0018) and OTT for theDFS (p=0.0360). The overall incidence of late complicationsin the rectum and bladder were 11.7 and 6.7%,respectively. In addition, insufficiency fractures wereobserved in 7 patients (5.8%). Conclusion: The results of this study suggest that radicalradiotherapy with HDR brachytherapy was appropriatefor the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significantprognostic factors. (Cancer Research and Treatment2004;36:222-227)
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