Tumour size in cancer of the cervix

In a randomized trial comprising 204 patients with operable cervical carcin omas stages I and II. two low-dose rates in gynaecological brachytherapy we re compared. Treatment consisted of Cs-137 uterovaginal application followe d by surgery (either immediate or delayed). The results for the two dose ra tes have been published previously. The present paper concerns the correlat ion between outcome and tumour size. Tumour size was carefully estimated in two ways. by clinical examination under general anaesthesia and by measure ments on the customized Vaginal mould used for the brachytherapy. Ninety-on e patients (45%) were classified as stage I, and 113 were classified as sta ge II proximal. The mean tumour size was 39 mm (range 15-64 min). Cox's mul tivariate analysis indicated that the factors with a poor prognostic value were for survival: node involvement (N +) (p < 0.001), large tumour size (T +) (p < 0.001) and involvement of the endocervix (E + ) (p < 0.01); for ev ent-free survival: N + (p < 0.001), T + (p < 0.001); for local control; N (p = 0.0001): for metastasis and regional relapse: N + (p < 0.001) and T (p < 0.001). Stage was not a prognostic factor over the present range in e ither univariate or multivariate analysis. In this series tumour size is a powerful independent prognostic factor. It is therefore suggested that for the classification of cervical cancer and the indications for surgical stag ing and adjuvant treatment, tumour size should be taken into account.