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Dose‐response and failure pattern for bulky or barrel‐shaped stage ib cervical cancer treated by combined photon irradiation and extrafascial hysterectomy
Author(s) -
Maruyama Yosh,
Van Nagell John R.,
Yoneda Justine,
Donaldson Elvis,
Gallion Holly H.,
Higgins Robert,
Powell Deborah,
Kryscio Richard,
Berner Barry
Publication year - 1989
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19890101)63:1<70::aid-cncr2820630112>3.0.co;2-q
Subject(s) - medicine , radiation therapy , hysterectomy , cervix , surgery , cervical cancer , chemoradiotherapy , stage (stratigraphy) , brachytherapy , radiology , cancer , paleontology , biology
From 1975 to 1987, 80 patients with bulky or barrel‐shaped Stage IB cervical cancer were treated with preoperative irradiation and Cs‐137 intracavitary implant therapy, before a planned extrafascial abdominal hysterectomy, using a consistent treatment policy. Of the hysterectomy specimens obtained, 37% were positive histologically at 89 ±2.3 days after the start of radiotherapy and at 4 to 6 weeks after the completion of radiation therapy. Sixty‐three percent were negative after a total external and internal cervix irradiation dose of 9642 cGy at point T. The average point A dose contributed by intracavitary therapy was 2104 cGy. The survival rate at 5 years was 84%: At 10 years the survival rate was 78%. The failure pattern was analyzed for patients who had positive and negative specimens. The patients with positive specimens failed pelvically or pelvically and distantly. Patients with negative specimens failed in extrapelvic or distant metastatic sites. Preoperative radiotherapy led to excellent local and pelvic control of tumor, and the failures became predominantly distant metastases. The combined radiosurgical therapy was tolerated well and allowed surgical staging of disease. This permitted earlier and selective consideration of adjuactive therapy ( i.e. , paraaortic irradiation, chemotherapy, or chemoradiotherapy). The dose‐response data give, insight into the effects of photon radiotherapy on bulky or barrel Stage IB cervical cancers and correlate histologic status with failure pattern, outcome, and long‐term survival.