EARLY AND LATE RADIOTHERAPEUTIC MORBIDITY IN 442 CONSECUTIVE PATIENTSWITH LOCALLY ADVANCED-CARCINOMA OF THE UTERINE CERVIX

Purpose: to evaluate the early and late radiotherapeutic morbidity aft er combined external and intracavitary radiotherapy to the uterine cer vix. Methods and Materials: The morbidity in 442 consecutive cervical cancer patients FIGO Stage IIB (139), IIIA (10), IIIB (221) and IVA (7 2) treated from 1974 to 1984 were recorded retrospectively according t o our own previously described system (18). This system is based on th e assumption that radiotherapeutic morbidity progresses in severity wi th time wherefore successive morbidity scoring rather than recording t he maximal damage alone is required to estimate the burden of complica tions for a group of patients. The early and late morbidity (within or beyond 3 months after the end of radiotherapy) was graded into mild, moderate, severe, and causing death depending on the symptoms and sign s, and the requirement and type of therapy. The late morbidity was cha racterized by both the frequency and the actuarially corrected estimat e. Also, the combined morbidity in two, three, four and five organs an d the probability of surviving without tumor recurrence and/or signifi cant late morbidity were evaluated. Results: Early morbidity was most frequently seen in the rectosigmoideum (61%) and urinary bladder (27%) . Medication for early morbidity was required in 68% and hospitalizati on in 10% of the patients. The frequencies of each late morbidity grad e did not differ in relation to FIGO Stage while the actuarial estimat es increased significantly with increasing stage. This reflects the po or prognosis in the more advanced stages, where few patients survived to develop late morbidity, and also points to the importance of latenc y in reporting late radiotherapeutic morbidity. In Stage IVA patients, the ratios between the actuarial estimate and the frequency of late s evere rectosigmoid and urinary bladder morbidity were as high as 2.5 a nd 3, respectively. The highest 5-year risks (+/- 1 SE of the estimate ) of late severe morbidity were found for the rectosigmoideum (28% +/- 3), small intestine (13% +/- 2) and urinary bladder (10% +/- 2). Rect osigmoid and urinary bladder complications constituted the most import ant part of the combined organ morbidity. Almost half of the patients developing late moderate rectosigmoid and one-third of those developin g late moderate bladder complications, did so within one year after ra diotherapy. Almost all complications were developed within 3 to 4 year s after radiotherapy. The probability of surviving without recurrence and/or severe combined rectosigmoid and urinary bladder morbidity was low (23% +/- 2). Conclusion: Actuarial estimates rather than frequenci es should be reported to avoid underestimation of the risk of late rad iotherapeutic morbidity in long-term survivors.