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Organ preservation in cervix cancer
I Barillot1, M C Bone-Lepinoy, J C Horiot
1Service de Radiothérapie, Centre G.F. Leclerc, Dijon, France.
Rays
|July 1, 1997
Summary
Radiotherapy for cervical cancer significantly reduced severe complications (G3-G4) with customized treatment planning (CTP), while maintaining high survival rates in early stages. Advanced stages require careful dose consideration.
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Clinical Oncology
Background:
- Radiotherapy alone was used to treat 642 patients with intact uterine cervix carcinoma between 1970 and 1994.
- Patient staging included 30% Stage I, 42% Stage II, and 28% Stage III/IV (FIGO substaging).
- Tumor characteristics included 38% with 3-5 cm diameter, 15% > 5 cm, and 21% nodal involvement.
Purpose of the Study:
- To analyze predictive factors for pelvic control and survival rates in cervical cancer patients treated with radiotherapy.
- To evaluate the impact of customized treatment planning (CTP) on severe complications (G3-G4).
Main Methods:
- Univariate and multivariate analyses were performed on predictive factors for treatment outcomes.
- Complications were assessed using the French-Italian Syllabus.
- The study evaluated the effect of CTP on G3-G4 complications, considering factors like FIGO substaging, external radiation dose (ED), parametrium boost (PB), and brachytherapy applicator (CA).
Main Results:
- Stage, tumor size, and nodal involvement were significant predictors of survival and pelvic control (p < 0.0001).
- Multivariate analysis identified CA as a predictor for G3-G4 bladder events (OR=10.8), and increased dose rate, CA use, and ED > 40 Gy for severe rectal sequelae.
- CTP implementation led to a decrease in severe complications; no G4 events occurred after 1983, and G3 rates significantly dropped across all stages.
Conclusions:
- Radiotherapy prescriptions based on tumor diameter and stage, delivered with CTP, eradicated lethal complications and reduced G3 complications while maintaining high cure rates in early stages.
- Survival rates in early stages (I and II) remained stable (91% and 85% respectively) with CTP.
- A decline in survival rates for advanced stages (III/IV) from 75% to 55% suggests potential underdosage or staging issues, warranting caution with dose reduction.