Clinical efficacy of applying four-field portals to paraaortic irradiationin the treatment of cervical carcinoma

Paraaortic nodal irradiation (PAI) was thought to be useful in the treatmen t of cervical cancer, but its clinical application has been limited by a re latively high morbidity. To reduce this morbidity, we routinely applied the four-field technique in PAI. To clarify its efficacy, clinical data were r etrospectively analyzed. Ninety-seven patients with cervical cancer, who re ceived a minimum 40 Gy of paraaortic irradiation between 1976 and 1994, wer e enrolled in the analysis. The patients mere prescribed PAI using four-fie ld portals with 10 MV photons (mean 50.4 Gy, range 40-70 Gy). The 5-year ca use-specific survival rate was 32.2%. As for sequelae determined using the French-Italian glossary, G1a/G2a of stomach and duodenum developed in 26.8/ 1.0%, G2b of small bowel in 3.1 %, Gib of nonspecific abdominal symptoms an d/or signs in 12.4%, and G2 of bone in 3.1%. The operative history group ha d a slightly larger incidence of gastrointestinal complications than those without operative history, but the difference was not statistically signifi cant. Application of four-field portals in PAI was useful, with acceptably low toxicity and successful compliance for moderate-to-high dose irradiatio n. This suggests that PAI may greatly contribute to the improvement of the therapeutic outcome of cervical carcinoma. (C) 1999 Wiley-Liss, Inc.