Treatment of advanced invasive cervical cancer: changing times and trends

A retrospective analysis of the treatment results and complications in 140 patients with advanced (Stage IIB or more) invasive cervical cancer treated at the Albert Einstein College of Medicine (AECOM) from 1962-1970 and the State University of New York at Buffalo (SUNYAB) from 1974-1982 is the subject of this report. All patients were clinically staged and received external pelvic radiotherapy followed by one to two intracavitary radium insertions, and those with histologically proven positive para-aortic nodes received on additional 4,500 to 5,000 rads to the para-aortic areas. Forty-four patients had pretherapy surgical staging (26 transperitoneal, 18 extraperitoneal). In the clinical staging group, a survival time of 5 years or longer was attained in 22 of 39 patients (56%); with Stage IIB, 11 of 30 patients (37%) with Stage IIIA, two of 13 patients with Stage IIIB and two of 12 patients with Stage IVA disease. Of 26 patients staged via transperitoneal approach, two survived more than 5 years and three others were alive at last contact (after more than 3 years follow-up). The last 18 patients have been subjected to laparoscopy and retroperitoneal pelvic and para-aortic node biopsies followed by tailored radiotherapy with [12] or without [6] chemotherapy. Chemotherapy consisted of alternating weekly courses of vincristine and bleomycin and hydroxyurea. Mitomycin-C was added to this regimen at the conclusion of the course of radiotherapy. Only one patient developed a vesicovaginal fistula. At last contact, seven patients in the combined therapy group were alive and free of disease. Combined therapy following extraperitoneal surgical staging appears to be feasible and justifiable. It deserves further trials in larger series.