Treatment Results of Radical Radiotherapy in Uterine Cervix Cancer

Huh, Seung Jae; Kim, Bo Kyong; Lim, Do Hoon; Shin, Seong Soo; Lee, Jeong Eun; Kang, Min Kyu; Ahn, Yong Chan

Abstract

PURPOSE: This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim.
MATERIALS AND METHODS
Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radiotherapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range 30.6~50.4 Gy to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of 24~28 Gy with 6~7 fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy.
RESULTS
Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was 82%, and 73%, and the disease free survival (DFS) rate was 72%, and 69%, at 3, and 5 years, respectively. The pelvic control rate (PCR) was 79% at both 3 and 5 years. According to the FIGO stage, 3 and 5 year OS were 100% and 50% in CIS/IA, 100% and 100% in IB, 83% and 69% in IIA, 87% and 80% in IIB, and 62% and 62% in III, respectively. The 3 year OS in 4 patients with stage IVA was 100%. Three-year DFS were 80% in CIS/IA, 88% in IB, 100% in IIA, 64% in IIB, 58% in III, and 75% in IVA. Three-year PCR were 100% in CIS/IA, 94% in IB, 100% in IIA, 84% in IIB, 69% in III, and 50% in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and treatment response had a borderline significance for DFS (p=0.0872). A total of 14 patients (13%) experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy.
CONCLUSION
HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less than 55 days had a positive impact on pelvic control and survival rate.