Fast growing cervical carcinomas - A retrospective analysis of 20 IB-IIBFIGO

Introduction: Fast growing cervix carcinomas have a pejorative outcome: the y may occur quickly after cervical smears qualified as normal - within an i nterval from 12 to 18 months in women less than 50 years old, and involvein g the endocervix. This retrospective analysis is aimed at assessing 5-year outcomes. Materials and methods: Twenty cases of fast-growing cancer of the uterine cervix classified according to the FIGO clinical staging system as IB (n=14), IIA (3), and IIB (3), have been reviewed and compared to a coho rt of 160 cases not having this feature. As regard to fast-growing carcinom a, the median age was 41 years (range 25-50), and the median follow-up 22 m onths (8-213) as compared to 54 years (27-79) and 80 months (5-199) for the reference cohort. The comparison of the two cohorts shows only a differenc e of breakdown which concerns the histological pelvic lymph nodes status (P <0.05), more often positive in fast-growing forms. The treatment policy was equally distributed between a radio-surgical approach, cesium 137 intracav itary irradiation followed by radical hysterectomy and lymphadenectomy, or a definitive irradiation with pelvic external irradiation followed by cesiu m 137 intracavitary irradiation. Results: Thirteen deaths are reported in t he fast-growing series instead of 54 in the other series. The 5-year overal l survival is, respectively, 34 (13-55) vs. 74% (68-82) (P<0.001), the loco -regional-free survival 58 (33-84) vs. 85% (79-81) (P<0.001), the 5-year me tastasis-free survival 61 (38-84) vs. 84% (78-90) (P=0.004). Conclusion: Th ese poor results emphasize the need to intensify loco-regional therapy with a concurrent cisplatin-based chemotherapy within the framework of a multid isciplinary approach. (C) 2000 Elsevier Science Ireland Ltd. All rights res erved.