Radiation therapy of cervical cancer. New developments

Invasive carcinoma of the cervix will be diagnosed in 13,500 women in the USA in 1992, of which a significant number will require radiation therapy.

Based on available information one can define optimal workup and staging, optimal radiation therapy, and the possibilities of interaction of radiation with surgery and chemotherapy in these cases.

The pelvic tumor control rates achieved with radiation therapy can reach close to 100% in subclinical tumor (Stage IA), range from 91-98% in Stage IB, but can be as low as 25-34% in Stage IVA. Survival is affected by the presence of metastatic tumor deposits outside the pelvis, which when present in the inguinal or para-aortic nodal regions can be controlled with irradiation. The 5-year survival can be as high as 92% for carcinoma of the cervix Stage I and as low as 28% in Stage III.

Radiation therapy can control the tumor in the pelvis in approximately 90% of patients with Stage I carcinoma of the cervix, but in only approximately 25% in patients with Stage IV disease. To increase tumor control, research is being conducted combining irradiation with chemotherapy, radiation sensitizers, hyperthermia, and new modalities such as neutron irradiation. Prophylactic para-aortic node irradiation is justified in some stages of the disease.