Stage IV-A carcinoma of the cervix

A review of 21 women irradiated because of stage IV-A carcinoma of the cervix was undertaken to determine whether applied external beam pelvic irradiation (EBPI) and intracavitary brachytherapy (ICB) for the disease would result in improved survival but at the price of irradiation-induced fistula formation in the tumor-involved bladder or rectum. Based on the 14 evaluable patients who received megavoltage EBPI, the five-year survival rate was better when EBPI was applied with ICB than with EBPI alone, 33% versus 0%, respectively (p = 0.06). All seven cases of vesicovaginal or rectovaginal fistulas were observed in the presence of malignant tumor. Fistula formation did not occur in any of the six patients who received EBPI with ICB.