HEURISTICALLY DERIVED TUMOR BURDEN SCORE AS A PROGNOSTIC FACTOR FOR STAGE IIIB CARCINOMA OF THE CERVIX

Purpose: A retrospective analysis of radiotherapeutic: management of l ocally advanced carcinoma of the uterine cervix was performed to evalu ate the effect of various treatment parameters and disease extent upon treat outcome. Methods and Materials: Between 1976 and 1989, 89 patie nts with Stage IIIB disease were treated with external beam radiothera py and brachytherapy. Treatment outcomes were evaluated by dose to Poi nt A, the proportion of Point A dose delivered by brachytherapy, clini cal response at 3 months, and a newly developed tumor burden scoring s ystem that quantifies the anatomical extent of disease. Kaplan-Meier e stimates of tumor control and survival parameters were determined. Res ults: Loco-regional control (LRC), disease-free survival (DFS), and ov erall survival (OVS) at 5 years were 52.9%, 45.5%, and 50.3%, respecti vely. Clinical response at 3 months was highly predictive of local and distant tumor control, There was no correlation between proportion of brachytherapy dose and treatment outcome. The tumor burden scoring sy stem demonstrates that FIGO Stage IIIB disease can be clinically divid ed into two prognostic groups of low and high tumor burden. Five year LRC was 62.9% and 40.2% for the low and high tumor burden groups, resp ectively (p = 0.024). Within the high tumor burden group the LRC was 5 3.0% and 22.5% when the point A dose given was > 78 Gy and less than o r equal to 78 Gy, respectively (p = 0.047). This correlated with impro ved DFS and OVS. Conclusion: The tumor burden scoring system subdivide s PICO Stage IIIB cervical carcinoma into two prognostic groups, predi cting for overall survival and demonstrating a dose response in the hi gh tumor burden group. This system may serve to improve future compari son of treatment outcome and to guide selection of patients who may be nefit from a more aggressive treatment approach.