| Results of Radiotherapy for the Uterine Cervical Cancer |
| Chul Yong Kim, Myung Sun Choi, Won Hyuck Suh |
| Department of Radiation Oncology, College of Medicine Korea University, Hae Wha Hospital, Seoul, Korea. |
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| ABSTRACT |
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One hundred fifty-four patients with the carcinoma of the uterine cervix were studied retrospectively to assess the result and impact of treatment at Department of Radiation Oncology, Korea University, Hae-Wha Hospital from Feb 1981 through Dec. 1986. Prior to radiotherapy, the patients were evaluated and staged by recommendation of FIgO including physical examination, pelvic examination, cystoscopy, ectosigmoidoscopy, chest X-ray, IVP, Ba enema. Also, an additional pelvic CT scan was obtained for some of the patients. The patients were treated by radiotherapy alone or adjuvant postoperative irradiation; In case of radiation therapy only, whole pelvic irradiation was given with C0-69 teletherapy unit via AP and PA parallel opposing fields or 4-oblique fields, 180 cgy per day, 5 days per week and intracavitary insertion was performed. In stages la, lb, and lla with small primary lesion, external irradiation was initially given to pelvis up to 2000~3000 cgy/2x(1/2)-3x(1/2) weeks and then intracavitary insert in was performed using Fletcher-Mini-Declos Applicator with cesium-137 courses and followed by external irradiation of 1000~2000 cgy 1x(1/2)-2x(1/2) weeks via AP and PA parallel opposing fields with midline shield to spare of bladder and rectum. However, if the primary lesion is large, external irradiation was given without midline shield. More than stage llb, the patients were treated by external beam irradiation up to 5400 cgy/30f for 6 weeks via 4-oblique portals and at the dose of 5040 cgy/28f the field was cut 5 cm from the top margin for spare of small bowel, and followed by intracavitary irradiation. If there was residual tumor, an additional dose of 900~1200 cgy/5~7f was given to parametrium and/or residual tumor area. Total dose of radiation of A and B-point were as follows; A-point : B-point In early stages, la, lb, llb ; 8000~9000 5000~6000 cgy In advanced stages llb, llla, lllb; 9000~10000 6000~7000 cgy The results were obtained and as follows; The patients distribution according to FIgO staging system were stage la 6, lb 27, lla 28, llb 54, llla 12, lllb 18, and stage lVa 9.
Value of CT scan were demonstration of cervix tumor mass, parametrial and pelvic side wall tumor spread, pelvic and inguinal lymph nodes metastases, and hydronephrosis. Three dimensional quantitative demonstration of tumor volume is also important in planning radiation therapy. Another advantage of CT scan was detection of recurrent tumor after radiation or surgery. Local control rate of tumor according to the size was 91.3% for less than 5 cm in size and 44.6% in tumor over 5 cm (p<0.0068). Thirty out of 50 recurrent sites has locoregional failures and 17 cases has distant metastases. And the papa-aortic lymph nodes were the most common site for distant metastases. The most common complication was temporal rectal bleeding which was controlled most by conservative management. However, 4 patients required for endoscopic cauterization. The 5-year survival rates showed; stage la and lb 95%, stage lla 81% stage llb 67%, stage llla 37.7%, stage lllb 23%, and 3-year survival rate of stage lVa showed 11.6%, retrospectively. |
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