ANALYSIS OF PROGNOSTIC FACTORS IN STAGE IIB-IVA CERVICAL-CARCINOMA TREATED WITH RADIATION-THERAPY - VALUE OF COMPUTED-TOMOGRAPHY

Purpose: To define the influence of the tumor size measured by compute d tomography (CT) and lymph node involvement detected by CT in patient s treated with radiation therapy for Stage IIB-IVA carcinoma of intact uterine cervix. Methods and Materials: This was a retrospective analy sis of 233 patients with uterine cervical cancer managed with both ext ernal irradiation and high-dose-rate intracavitary brachytherapy (HDR- ICR) at Kanagawa Cancer Center. The results were analyzed for the end points of absolute survival (AS), disease-free survival (DFS), pelvic control (PC), and central control (CC). The parameters of stage, CT-me asured anterior-posterior (AP) cervix size, and CT-detected lymph node metastases were evaluated using univariate and multivariate analysis. Results: The stage, AP cervix size, and lymph node involvement were s ignificant pretreatment factors in univariate analysis with respect to AS, DFS, PC, and CC. Multivariate analysis confirmed that significant risk was associated with certain prognostic parameters. Those in term s of AS, in order of decreasing significance, were lymph node involvem ent, AP cervix size, age, and total HDR-ICR dose. When DFS was studied , lymph node involvement and AP cervix size were demonstrated to have a significant effect. Stage and lymph node involvement significantly a ffected PC. Conclusion: Because the International Federation of Gyneco logical Obstetrics staging system fails to incorporate important progn ostic information about tumor volume and lymph node involvement, CT-de tected lymph node metastases as well as CT-measured cervix size should be determined as complementary additional prognostic measures. (C) 19 97 Elsevier Science Inc.