Radiation therapy alone in stage III-B cancer of the uterine cervix - A 17-year experience in Southern Brazil

Purpose: External irradiation followed by intracavitary therapy (EBIC) has been considered the standard treatment for stage III-B cancer of the uterin e cervix. For different reasons, some patients are not suited for intracavi tary therapy (ICT), and the treatment may be given entirely by external bea m irradiation alone (EBRTA). The purpose of our study is to discuss treatme nt results and complications for patients undergoing EBIC or EBRTA. Methods and Materials: A retrospective study was carried out on 202 eligibl e patients with stage III-B cancer of the uterine cervix admitted for radio therapy from 1980-1997. Ninety-three patients were able to receive EBIC (50 Gy, 8 MV RX whole pelvis followed by one session of 38-45 Gy ICT to point A). The remaining received EBRTA (50-70 Gy for 5-9 or more weeks). Median f ollow-up procedure was 18.5 months (range: 4-182) for all patients and 26 m onths (range 4-147) for the patients at risk. Results: The most frequent reason for precluding ICT was large residual tum or volume (32.1%). Ten-year overall survival rates, relapse free survival, and pelvic failure rate for the EBIC and EBRTA patients were, respectively, 22.5% x 15.6% (p = 0.0087), 23.5% x 14.8% (p = 0.005), and 51.6% x 68.8% ( p = 0.005). However, when the same comparisons were performed with EBIC pat ients x EBRTA patients receiving a high dose schedule (60 Gy/6-8 wk to 70 G y/7-9 wk), the results of the EBIC group remained higher, but the differenc es became insignificant: respectively, 22.5% x 18.9% (p = 0.17), 23.5% x 15 .3% (p = 0.052), and 51.6% x 60.0% (p = 0.10). The distribution of complica tions was similar in both groups. Conclusions: We found that EBIC was the best treatment modality in our pati ents with stage III-B cancer of the uterine cervix, whereas for patients wh o were not candidates for ICT, EBRTA with a high dose schedule appears to b e an efficient and safe alternative. (C) 1999 Elsevier Science Inc.