DEFINITIVE RADIOTHERAPY COMBINED WITH HIGH-DOSE-RATE BRACHYTHERAPY FOR STAGE-III CARCINOMA OF THE UTERINE CERVIX - RETROSPECTIVE ANALYSIS OF PROGNOSTIC FACTORS CONCERNING PATIENT CHARACTERISTICS AND TREATMENT PARAMETERS

Purpose: To assess treatment outcome after definitive radiotherapy for Stage III cervical carcinoma retrospective analysis of the clinical d ata was performed. Methods and Materials: We enrolled 265 patients wit h Stage III cervical carcinoma who were treated with combined external beam radiotherapy (mean +/- standard deviation (SD), 50.3 +/- 1.8 Gy; range 40-70) and intracavitary brachytherapy (ICBT) (mean +/- SD, 19. 8 +/- 2.4 Gy; range 10-32) using a high-dose-rate Co-60 source. We ret rospectively analyzed, as measures of the therapeutic outcome, the ove rall survival rate (OAS), relapse-free survival rate (RFS), locoregion al event-free rate (LREF), distant metastasis (DM), and late complicat ion. Results: The 5-year OAS, RFS, and LREF rates (n = 265) were 50.7% , 57.1%, and 71.2%, respectively. Univariate analysis revealed a signi ficant favorable effect on the OAS rate for complete response (CR) (p = 0.024), maximum tumor diameter < 6 cm (SML) (p = 0.0009), Karnofsky performance score greater than or equal to 70 (p = 0.046), age <75 yea rs (p = 0.0043), hemoglobin (Hb) concentration of greater than or equa l to 9 g/dl (p = 0.0005), and histopathological diagnosis of squamous cell carcinoma (SCC) (p = 0.0089). In the multivariate analysis, Hb, S CC, SML, and CR remained significant prognostic factors. In both univa riate and multivariate analysis, SML, Hb, age, and SCC showed signific ant effects on the RFS rate. Age greater than or equal to 60 years (p = 0.017), Hb greater than or equal to 9 g/dl (p = 0.0039), and SML (p = 0.0046) were significant favorable prognostic factors for the LREF r ate identified by univariate analysis. In addition, advanced age, SML, and SCC showed significant beneficial effects on the LREF rate in the multivariate analysis. DM developed in 21.1% of patients, and the gro ups with Hb < 9 g/dl (p < 0.005), Karnofsky performance score of <70 ( p < 0.001), and dose at point A in the ICBT < 16 Gy (p < 0.005) develo ped a significantly greater incidence of DM than did the groups withou t. The 5-year incidence was 2.6% for major bladder complication and 8. 3% for major rectal complication. The radiation dose in the subgroup w ith rectal complication was significantly greater than that in the sub group without complications. Conclusion: In patients with stage III ce rvical carcinoma, tumor size, concentration of Hb, and histopathologic al diagnosis are strong prognostic factors for the therapeutic outcome . The ICBT dose in our study was small compared to the reported data, but the outcome was quite comparable. Thus, the dose we used might be the minimum required. However, locoregional control still remains an i mportant problem. It is necessary to attain the optimal dose distribut ion in both the target volume and in critical organs. In high-risk pat ients, combined use of chemotherapy is crucial to improve the response to radiation. (C) 1998 Elsevier Science Inc.