Tumor apoptosis in cervical cancer: Its role as a prognostic factor in 42 radiotherapy patients

To investigate tumor apoptosis as a prognostic factor for outcome following radiation therapy, comparisons were made of apoptotic index (AI) as a pred ictor of short vs. long-term response and pretreatment vs. radiation-induce d apoptosis. Forty-two patients with proven squamous cell carcinoma of the uterine cervix were treated by radiation alone. Apoptosis was measured by l ight microscopic observation of hematoxylin and eosin-stained sections from biopsies taken before treatment and 4 and 24 hr after 2 Gy. Patients were evaluated at the end of the external radiation for determination of short-t erm response and for long-term outcome as well (median follow-up of 27 mont hs). Patients with high spontaneous AI showed poor short-term response, loc al control, and survival. The significance of AI as a predictor of short-te rm response was lost after allowing for differences in tumor size. The posi tive predictive value of AI for local control and survival was independent of tumor size and stage. High Al was associated with poor local control and long-term prognosis in advanced squamous cell carcinoma of the cervix. The in vivo radiation-induced AI after 4 or 24 hr did not predict radiation th erapy outcome. (C) 2001 Wiley-Liss, Inc.