Analysis of results of radiation therapy for stage II carcinoma of the cervix

Abstract

From April 1969 through December 1980, 251 patients with invasive, epidermoid carcinoma of the cervix received radical radiation therapy consisting of a combination of external beam and intracavitary therapy designed to deliver 7000 to 8000 rad to Point A and 6000 to 6500 rad to the pelvic lymph nodes. The disease-free survival at 2, 5, and 10 years for patients with Stage IIA disease was 90%, 76%, and 76%, respectively, whereas for patients with Stage IIB disease it was 77%, 62%, and 59%, respectively. The survival for the entire group at 2, 5, and 10 years was 80%, 65%, and 62%, respectively. Sixty-eight patients had a recurrence within the irradiated volume, for a locoregional recurrence rate of 27% (68/251). In 49 patients complications developed for an overall complication rate of 19.5% (49/251). An analysis of the complications and their degree of severity revealed a correlation with the dose of intracavitary plus external beam therapy given to Point A and to the rectum. The mean dose to Point A for patients with and without complications were 7877 rad (standard error [SE] ± 95) and 7593 rad (SE ± 67), respectively. The mean rectal dose for patients with and without intestinal complications were 6767 rad (SE ± 157) and 6426 rad (SE ± 78), respectively. The dose difference between patients with and without complications was statistically significant for Point A (P = 0.0163) but not for the rectal dose (P = 0.0887). There was no correlation between the bladder dose and urinary complications. Other treatment methods as well as patient and tumor parameters, are being currently analyzed to identify which factors, singly or in combination, may contribute to the development of treatment failures or complications.