Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix

Patients with locally advanced cervical cancer are often severely distressed with incessant vaginal bleeding, offensive discharge and pelvic pain and are in some instances are beyond curative potential. At our institution we routinely use monthly palliative pelvic radiotherapy for these patients.

One hundred patients treated between 2000 & 2004 were included in this analysis. Patients were treated with parallel-opposed pelvic portals with megavoltage radiation monthly up to a maximum of three fractions (10 Gy/fraction). Patients with good response after second fraction were considered for intracavitary brachytherapy delivering 30 Gy to point A. Response was documented with regard to relief of bleeding, vaginal discharge and pelvic pain. The other aspects evaluated were patient compliance, disease response, toxicity and survival.

Sixty-eight percent had FIGO stage IIIB, 12% had stage IVA and 14% had IVB disease. Twenty patients had metastatic disease. The median symptom duration was 5 months. Majority (67%) presented with vaginal bleeding, followed by discharge (69%) and pelvic pain (48%). All patients received at least one fraction of palliative pelvic radiotherapy. Sixty-one patients received the second fraction and 33 the third. Five patients received an intracavitary application. The overall response rates in terms of control of bleeding, discharge and pain were 100%, 49% and 33% respectively. The treatment was generally well tolerated with a median survival of 7 months.

Monthly palliative pelvic radiotherapy results in satisfactory control of symptoms in patients with locally advanced carcinoma of cervix with acceptable complications.