CARCINOMA OF THE UTERINE CERVIX IN SAUDI-ARABIA - EXPERIENCE IN THE MANAGEMENT OF 164 PATIENTS WITH STAGE-I AND STAGE-II DISEASE

Background: Earlier stages cervical cancer has been customarily treate d with radiation therapy, surgery, or combination thereof. We present our experience in the management of stage-I and -II patients in a majo r cancer center in the Kingdom of Saudi Arabia. Methods: Between 1979 and 1991, 164 patients were treated and closely followed at a tertiary care medical center. Results: Patients accounted for 0.78% of all can cer patient referral. More cases with earlier stages (41.3%) were refe rred since 1986, compared to a lower referral (26.1%) during the earli er part of the study (p = 0.027). Age ranged from 21 to 80 years with a median of 46.5 years. Clinical stages at presentation included Stage -IA (3.0%), LB (28.7%), IIA (11.6%), and IIB (56.7%). Majority (87.2%) had squamous cell carcinoma, while the rest, had adenocarcinoma (9.1% ) or other malignancies (3.6%). Among the 143 patients with squamous c ell cancer, eighteen had attempted radical resection, 101 were treated with radiation, and 24 had both modalities. For squamous cancer patie nts, fifty-one (35.7%) had disease relapse either locally (19 cases), distally (23 patients) or both combined (9 patients). The pattern of f ailure was unrelated to stage of disease, histological diagnosis or th e mode of therapy initially administered. The cumulative five and ten year's survival for squamous cancer patients was 68.3% and 57.9% respe ctively. Better survival was noted for patients with smaller sized tum ors, free parametrium, and Stage-I disease. When all factors were cons idered in the regression model, only the status of parametrial involve ment was found to be of significance. Conclusions: Cervical cancer is relatively rare in Saudi Arabia. With the improvement in health care d elivery, more patients were lately seen at earlier stages of disease. With radiation therapy, two thirds of patients survived five years. Th e extent of parametrial involvement was the best predictor for long te rm survival. (C) 1998 Elsevier Science Inc.