Pj. Eifel et al., Patterns of radiotherapy practice for patients with squamous carcinoma of the uterine cervix: Patterns of care study, INT J RAD O, 43(2), 1999, pp. 351-358
Citations number
17
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Purpose: To determine the impact of research findings and evolving technolo
gy on the patterns of radiotherapy practice for patients with carcinoma of
the uterine cervix.
Methods and Materials: Sixty-two radiation therapy facilities participated
in the study after having been selected from a random sample, proportionall
y stratified according to practice type, of all United States facilities. E
ach facility submitted a list of patients treated during 1992-1994 with rad
iation for squamous carcinoma of the cervix. Cases for review were randomly
selected from each institution after excluding those of patients who had d
istant metastases or initial hysterectomy. A total of 471 patients' records
were reviewed in the treating institutions to obtain information about pat
ients' characteristics, diagnostic evaluation, tumor extent, treatment appr
oach, and radiotherapy techniques.
Results: Of the 61 facilities that treated eligible cases of intact cervica
l cancer during the 3-year survey period, 35 (57%) treated fewer than three
eligible patients per year. Thirty-four (83%) of 41 non-academic facilitie
s vs. 1 (5%) of 20 academic facilities treated fewer than three patients pe
r year. FIGO stages were I, II, III, and IV in 32%, 40%, 24%, and 3% of pat
ients, respectively. Computed tomography (CT) was the most common method of
lymph node evaluation, but surgical evaluation, which was performed in 76
(16%) patients, had increased from previous surveys. Fields were designed u
sing a dedicated simulator in 95% of patients; a dedicated CT unit was used
for treatment planning in 119(30%) cases. External beam irradiation was mo
st often given using a four-field technique at 180 cGy per day on a 10-20 M
V linear accelerator. The average daily fraction size had decreased from pr
evious surveys, and 13% of patients were treated with daily doses of 170 cG
y or less. Most patients were treated with a combination of external beam a
nd low dose-rate (LDR) intracavitary irradiation. Of 425 patients who had t
reatment with curative intent that included brachytherapy, 362 (85%) had LD
R brachytherapy, 45 (11%) had high dose-rate (HDR) brachytherapy, 3 had a c
ombination of HDR and LDR, and 15 had incomplete information about the brac
hytherapy dose-rate. Forty-six (23%) of 197 patients with Stages I-IIA dise
ase were treated with radiation followed by extrafascial hysterectomy. Of 1
11 patients treated with curative intent for Stage III-IV disease, 72 (65%)
had a combination of external beam and intracavitary radiation therapy, 22
(20%) had external beam plus interstitial brachytherapy, and 17 (15%) were
treated with external beam irradiation only. For patients who completed tr
eatment with curative intent and did not have adjuvant hysterectomy or HDR
brachytherapy, the median total dose at point A was 82.5 Gy. For all patien
ts who completed treatment with radiation alone, the median total duration
of treatment was 63 days; more than 70 days were taken to complete treatmen
t in 33% of cases. Twenty-nine percent of patients received chemotherapy, u
sually concurrent with their radiation therapy. Only 27% of these patients
were on investigational protocols.
Conclusions: Greater participation in well-designed prospective trials migh
t help clinicians address important clinical questions and reduce current i
nconsistencies in the use of adjuvant treatments. Radiation oncologists sho
uld take steps to avoid unnecessary treatment protraction and to improve pa
tient compliance. Future studies will be needed to determine whether the sm
all number of cases being treated in most nonacademic facilities will influ
ence the outcome for patients with invasive cervical carcinoma. (C) 1999 El
sevier Science Inc.