Evaluation of external beam therapy and three brachytherapy fractions for carcinoma of the uterine cervix.

Abstract

A retrospective analysis was performed to evaluate external beam therapy and three brachytherapy fractions for patients with squamous cell carcinoma of the uterine cervix, compared with those with other histological types. Three hundred and twenty-two patients with carcinoma of the uterine cervix received external pelvic irradiation combined with three sessions of low dose rate intracavitary irradiation within 6 weeks. Two hundred and ninety-three patients had squamous cell carcinoma (SCC), whereas 29 patients had nonsquamous cell histology (N-SCC): 18 had adenocarcinoma, 5 had undifferentiated carcinoma, 4 had adenosquamous carcinoma, and 2 had adenoacanthoma. Survival rates, patterns of failure, local control rates, and complications in the patients with SCC were compared with those in the patients with N-SCC. The 5-year overall actuarial survival rates for the patients with SCC and for those with N-SCC were: 84% and 100% in Stage I disease, 72% and 38% in Stage II disease, 52% and 17% in Stage III disease, and 29% and 0% in Stage IV disease, respectively. The 5-year cause specific survival rates for the patients with SCC in Stages I to IV disease were 100%, 87%, 72%, and 39%. Corresponding rates for the patients with N-SCC were 100%, 43%, 25%, and 0%. There was a statistically significant difference between the survival curves for two histological types in Stage II B, III B, and IV A diseases. The local control for the patients with N-SCC was worse than in the patients with SCC. The crude moderate and severe rectal complication rates (Grades 3 and 4) for the patients with SCC and for the patients with N-SCC were 7.5% and 3.4%, respectively. Only one patient with SCC developed chronic small intestinal injury in this series. We observed four patients with SCC who developed Grade 2 and four with Grade 4 urinary bladder complications. Three sessions of intracavitary brachytherapy were a safe and effective procedure for the patients with SCC and the outcome of radiation therapy in the patients with SCC was satisfactory even in advanced cases. However, local control of N-SCC is difficult to achieve by this method and the prognosis for patients with N-SCC was significantly worse than that for patients with SCC.