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Prawat Padoongcharoen - One of the best experts on this subject based on the ideXlab platform.
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high dose rate cobalt 60 after loading Intracavitary Therapy of the uterine cervical carcinoma in srinagarind hospital analysis of residual disease
Asian Pacific Journal of Cancer Prevention, 2012Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:Objectives: To evaluate residual disease in uterine cervical cancer patients treated with teleTherapy using combined high dose rate Cobalt-60 brachyTherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, FIGO stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radioTherapy alone between April 1986 and December 1988 was conducted and the outcomes analysed. The patients were treated using teleTherapy 50 Gy/25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachyTherapy of 850 cGy/fraction, weekly to point A for 2 fractions. Results: The study covered 141 patients with uterine cervical cancer. The mean age was 50.0 years with a range of 30-78 years. The mean tumor size was 4.1 cm in diameter (range 1-8 cm). Mean follow - up time was 2.94 years (range 1 month-6.92 years). The overall incidence of residual locoregional disease was 3.5%. Residual disease, according to stage IIB, IIIB and IVA was present in 2.78%, 3.37% and 50.0%. It was noted that there was no evidence of residual disease in stage IB and IIA cases. Conclusion: Combined teleTherapy along with high dose rate Cobalt -60 brachyTherapy of 850 cGy/fraction, weekly to point A for 2 fractions resulted in overall 3.5% residual disease and a 96.5% complete response. The proposed recommendation for improving outcome is initiation of measurements for early detection of disease.
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high dose rate cobalt 60 afterloading Intracavitary Therapy for cervical carcinoma in srinagarind hospital analysis of survival
Asian Pacific Journal of Cancer Prevention, 2010Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:Objective: To evaluate the actuarial survival rates in uterine cervical cancer patients treated with teleTherapy combined with high dose rate (HDR) cobalt-60 brachyTherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations or FIGO), treated by radioTherapy alone between April 1986 and December 1988 was conducted. The patients were treated with teleTherapy 50Gy/25 fractions, five fractions per week to the whole pelvis, together with HDR cobalt-60 afterloading brachyTherapy of 850 cGy/ fraction, weekly to point A for 2 fractions. Results:The study analysed the records of 141 patients with uterine cervical cancer with a mean age of 50.0 years (range 30-78). The mean tumor size was 4.1 cm in diameter (range 1-8). Mean follow-up time was 2.94 years (range 1 month - 6.92 years). The 5 year actuarial survival rates for patients with small size tumors less than 2 cm in diameter and tumor sizes larger than 2 cm in diameter were 100% and 63.2%. The overall 5 year survival rate was 63.3%. For cancer stages IB, IIB, IIIA and IIIB they were 100%, 80.3%, 100% and 54.8% and for squamous cell carcinoma and adenocarcinoma were 58.3% and 31.2%. Conclusion: Combined HDR cobalt-60 brachyTherapy and external beam radioTherapy provide a useful modality in the treatment of uterine cervical cancer, feasible for developing countries. The approach demonstrated a slightly elevated radiation morbidity but was most effective in early stages and with small tumor sizes less than 2 cm in diameter.
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high dose rate cobalt 60 afterloading Intracavitary Therapy of uterine cervical carcinomas in srinagarind hospital analysis of complications
Asian Pacific Journal of Cancer Prevention, 2010Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:OBJECTIVES To evaluate complications in uterine cervical cancer patients treated with teleTherapy combined with high dose rate(HDR) cobalt-60 brachyTherapy. MATERIALS AND METHODS A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radioTherapy alone between April 1986 and December 1988 was conducted. The patients received teleTherapy 50 Gy / 25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachyTherapy of 850 cGy/ fraction weekly to point A for 2 fractions. RESULTS The study subjects were 141 patients with uterine cervical cancer. The mean age was 49 years with a range of 30-78. The mean tumor size was 4.1 cms in diameter (range 1-8 cms ). Mean follow-up time was 2.9 years (range 1 month - 6.9 years). The treatments resulted in a 96.5% complete response rates but morbidity rates of grade 1 and grade 2 radiation proctitis of 27.0%, and 10.6 %. The grade 1 and grade 2 radiation cystitis were 1.4%, and 1.4 %. At the level of grade 3 radiation complications, 0.71% of radiation proctitis and 0.71% small bowel obstruction were observed. The mean onset time to develop radiation proctitis after complete treatment was 15 months with a range of 6-61 months, for radiation cystitis was 30 months (range 9 - 47 months) and for small bowel obstruction was 53 months in the one case it occurred. CONCLUSION Combined teleTherapy along with high dose rate Cobalt -60 brachyTherapy of 850 cGy/ fraction, weekly to point A for 2 fractions for uterine cancer demonstrated a slightly higher incidence of grade 2 radiation proctitis. Therefore, treatment using HDR-60 brachyTherapy less than 850 cGy per fractionation for decreasing the grade 2 and grade 3 radiation morbidity is recommended.
Montien Pesee - One of the best experts on this subject based on the ideXlab platform.
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high dose rate cobalt 60 after loading Intracavitary Therapy of the uterine cervical carcinoma in srinagarind hospital analysis of residual disease
Asian Pacific Journal of Cancer Prevention, 2012Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:Objectives: To evaluate residual disease in uterine cervical cancer patients treated with teleTherapy using combined high dose rate Cobalt-60 brachyTherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, FIGO stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radioTherapy alone between April 1986 and December 1988 was conducted and the outcomes analysed. The patients were treated using teleTherapy 50 Gy/25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachyTherapy of 850 cGy/fraction, weekly to point A for 2 fractions. Results: The study covered 141 patients with uterine cervical cancer. The mean age was 50.0 years with a range of 30-78 years. The mean tumor size was 4.1 cm in diameter (range 1-8 cm). Mean follow - up time was 2.94 years (range 1 month-6.92 years). The overall incidence of residual locoregional disease was 3.5%. Residual disease, according to stage IIB, IIIB and IVA was present in 2.78%, 3.37% and 50.0%. It was noted that there was no evidence of residual disease in stage IB and IIA cases. Conclusion: Combined teleTherapy along with high dose rate Cobalt -60 brachyTherapy of 850 cGy/fraction, weekly to point A for 2 fractions resulted in overall 3.5% residual disease and a 96.5% complete response. The proposed recommendation for improving outcome is initiation of measurements for early detection of disease.
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high dose rate cobalt 60 afterloading Intracavitary Therapy for cervical carcinoma in srinagarind hospital analysis of survival
Asian Pacific Journal of Cancer Prevention, 2010Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:Objective: To evaluate the actuarial survival rates in uterine cervical cancer patients treated with teleTherapy combined with high dose rate (HDR) cobalt-60 brachyTherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations or FIGO), treated by radioTherapy alone between April 1986 and December 1988 was conducted. The patients were treated with teleTherapy 50Gy/25 fractions, five fractions per week to the whole pelvis, together with HDR cobalt-60 afterloading brachyTherapy of 850 cGy/ fraction, weekly to point A for 2 fractions. Results:The study analysed the records of 141 patients with uterine cervical cancer with a mean age of 50.0 years (range 30-78). The mean tumor size was 4.1 cm in diameter (range 1-8). Mean follow-up time was 2.94 years (range 1 month - 6.92 years). The 5 year actuarial survival rates for patients with small size tumors less than 2 cm in diameter and tumor sizes larger than 2 cm in diameter were 100% and 63.2%. The overall 5 year survival rate was 63.3%. For cancer stages IB, IIB, IIIA and IIIB they were 100%, 80.3%, 100% and 54.8% and for squamous cell carcinoma and adenocarcinoma were 58.3% and 31.2%. Conclusion: Combined HDR cobalt-60 brachyTherapy and external beam radioTherapy provide a useful modality in the treatment of uterine cervical cancer, feasible for developing countries. The approach demonstrated a slightly elevated radiation morbidity but was most effective in early stages and with small tumor sizes less than 2 cm in diameter.
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high dose rate cobalt 60 afterloading Intracavitary Therapy of uterine cervical carcinomas in srinagarind hospital analysis of complications
Asian Pacific Journal of Cancer Prevention, 2010Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:OBJECTIVES To evaluate complications in uterine cervical cancer patients treated with teleTherapy combined with high dose rate(HDR) cobalt-60 brachyTherapy. MATERIALS AND METHODS A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radioTherapy alone between April 1986 and December 1988 was conducted. The patients received teleTherapy 50 Gy / 25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachyTherapy of 850 cGy/ fraction weekly to point A for 2 fractions. RESULTS The study subjects were 141 patients with uterine cervical cancer. The mean age was 49 years with a range of 30-78. The mean tumor size was 4.1 cms in diameter (range 1-8 cms ). Mean follow-up time was 2.9 years (range 1 month - 6.9 years). The treatments resulted in a 96.5% complete response rates but morbidity rates of grade 1 and grade 2 radiation proctitis of 27.0%, and 10.6 %. The grade 1 and grade 2 radiation cystitis were 1.4%, and 1.4 %. At the level of grade 3 radiation complications, 0.71% of radiation proctitis and 0.71% small bowel obstruction were observed. The mean onset time to develop radiation proctitis after complete treatment was 15 months with a range of 6-61 months, for radiation cystitis was 30 months (range 9 - 47 months) and for small bowel obstruction was 53 months in the one case it occurred. CONCLUSION Combined teleTherapy along with high dose rate Cobalt -60 brachyTherapy of 850 cGy/ fraction, weekly to point A for 2 fractions for uterine cancer demonstrated a slightly higher incidence of grade 2 radiation proctitis. Therefore, treatment using HDR-60 brachyTherapy less than 850 cGy per fractionation for decreasing the grade 2 and grade 3 radiation morbidity is recommended.
Srichai Krusun - One of the best experts on this subject based on the ideXlab platform.
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high dose rate cobalt 60 after loading Intracavitary Therapy of the uterine cervical carcinoma in srinagarind hospital analysis of residual disease
Asian Pacific Journal of Cancer Prevention, 2012Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:Objectives: To evaluate residual disease in uterine cervical cancer patients treated with teleTherapy using combined high dose rate Cobalt-60 brachyTherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, FIGO stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radioTherapy alone between April 1986 and December 1988 was conducted and the outcomes analysed. The patients were treated using teleTherapy 50 Gy/25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachyTherapy of 850 cGy/fraction, weekly to point A for 2 fractions. Results: The study covered 141 patients with uterine cervical cancer. The mean age was 50.0 years with a range of 30-78 years. The mean tumor size was 4.1 cm in diameter (range 1-8 cm). Mean follow - up time was 2.94 years (range 1 month-6.92 years). The overall incidence of residual locoregional disease was 3.5%. Residual disease, according to stage IIB, IIIB and IVA was present in 2.78%, 3.37% and 50.0%. It was noted that there was no evidence of residual disease in stage IB and IIA cases. Conclusion: Combined teleTherapy along with high dose rate Cobalt -60 brachyTherapy of 850 cGy/fraction, weekly to point A for 2 fractions resulted in overall 3.5% residual disease and a 96.5% complete response. The proposed recommendation for improving outcome is initiation of measurements for early detection of disease.
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high dose rate cobalt 60 afterloading Intracavitary Therapy for cervical carcinoma in srinagarind hospital analysis of survival
Asian Pacific Journal of Cancer Prevention, 2010Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:Objective: To evaluate the actuarial survival rates in uterine cervical cancer patients treated with teleTherapy combined with high dose rate (HDR) cobalt-60 brachyTherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations or FIGO), treated by radioTherapy alone between April 1986 and December 1988 was conducted. The patients were treated with teleTherapy 50Gy/25 fractions, five fractions per week to the whole pelvis, together with HDR cobalt-60 afterloading brachyTherapy of 850 cGy/ fraction, weekly to point A for 2 fractions. Results:The study analysed the records of 141 patients with uterine cervical cancer with a mean age of 50.0 years (range 30-78). The mean tumor size was 4.1 cm in diameter (range 1-8). Mean follow-up time was 2.94 years (range 1 month - 6.92 years). The 5 year actuarial survival rates for patients with small size tumors less than 2 cm in diameter and tumor sizes larger than 2 cm in diameter were 100% and 63.2%. The overall 5 year survival rate was 63.3%. For cancer stages IB, IIB, IIIA and IIIB they were 100%, 80.3%, 100% and 54.8% and for squamous cell carcinoma and adenocarcinoma were 58.3% and 31.2%. Conclusion: Combined HDR cobalt-60 brachyTherapy and external beam radioTherapy provide a useful modality in the treatment of uterine cervical cancer, feasible for developing countries. The approach demonstrated a slightly elevated radiation morbidity but was most effective in early stages and with small tumor sizes less than 2 cm in diameter.
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high dose rate cobalt 60 afterloading Intracavitary Therapy of uterine cervical carcinomas in srinagarind hospital analysis of complications
Asian Pacific Journal of Cancer Prevention, 2010Co-Authors: Montien Pesee, Srichai Krusun, Prawat PadoongcharoenAbstract:OBJECTIVES To evaluate complications in uterine cervical cancer patients treated with teleTherapy combined with high dose rate(HDR) cobalt-60 brachyTherapy. MATERIALS AND METHODS A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radioTherapy alone between April 1986 and December 1988 was conducted. The patients received teleTherapy 50 Gy / 25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachyTherapy of 850 cGy/ fraction weekly to point A for 2 fractions. RESULTS The study subjects were 141 patients with uterine cervical cancer. The mean age was 49 years with a range of 30-78. The mean tumor size was 4.1 cms in diameter (range 1-8 cms ). Mean follow-up time was 2.9 years (range 1 month - 6.9 years). The treatments resulted in a 96.5% complete response rates but morbidity rates of grade 1 and grade 2 radiation proctitis of 27.0%, and 10.6 %. The grade 1 and grade 2 radiation cystitis were 1.4%, and 1.4 %. At the level of grade 3 radiation complications, 0.71% of radiation proctitis and 0.71% small bowel obstruction were observed. The mean onset time to develop radiation proctitis after complete treatment was 15 months with a range of 6-61 months, for radiation cystitis was 30 months (range 9 - 47 months) and for small bowel obstruction was 53 months in the one case it occurred. CONCLUSION Combined teleTherapy along with high dose rate Cobalt -60 brachyTherapy of 850 cGy/ fraction, weekly to point A for 2 fractions for uterine cancer demonstrated a slightly higher incidence of grade 2 radiation proctitis. Therefore, treatment using HDR-60 brachyTherapy less than 850 cGy per fractionation for decreasing the grade 2 and grade 3 radiation morbidity is recommended.
Mary Ann Lockett - One of the best experts on this subject based on the ideXlab platform.
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factors affecting long term outcome of irradiation in carcinoma of the vagina
International Journal of Radiation Oncology Biology Physics, 1999Co-Authors: Carlos A Perez, Perry W Grigsby, M Garipagaoglu, David G Mutch, Mary Ann LockettAbstract:OBJECTIVE: This report evaluates prognostic and technical factors affecting outcome of patients with primary carcinoma of the vagina treated with definitive radiation Therapy. METHODS AND MATERIALS: A retrospective analysis was performed on records of 212 patients with histologically confirmed carcinoma of the vagina treated with irradiation. RESULTS: Tumor stage was the most significant prognostic factor; actuarial 10-year disease-free survival was 94% for Stage 0 (20 patients), 80% for Stage I (59 patients), 55% for Stage IIA (63 patients), 35% for Stage IIB (34 patients), 38% for Stage III (20 patients), and 0% for Stage IV (15 patients). All in situ lesions except one were controlled with Intracavitary Therapy. Of the patients with Stage I disease, 86% showed no evidence of vaginal or pelvic recurrence; most of them received interstitial or Intracavitary Therapy or both, and the addition of external-beam irradiation did not significantly increase survival or tumor control. In Stage IIA (paravaginal extension) and IIB (parametrial involvement) 66% and 56% of the tumors, respectively, were controlled with a combination of brachyTherapy and external-beam irradiation; 13 of 20 (65%) Stage III tumors were controlled in the pelvis. Four patients with Stage IV disease (27%) had no recurrence in the pelvis. The total incidence of distant metastases was 13% in Stage I, 30% in Stage IIA, 52% in Stage IIB, 50% in Stage III, and 47% in Stage IV. The dose of irradiation delivered to the primary tumor or the parametrial extension was of relative importance in achieving successful results. In patients with Stage I disease, brachyTherapy alone achieved the same local tumor control (80-100%) as in patients receiving external pelvic irradiation (78-100%) as well. In Stage II and III there was a trend toward better tumor control (57-80%) with combined external irradiation and brachyTherapy than with the latter alone (33-50%) (p = 0.42). The incidence of grade 2-3 complications (12%) correlated with the stage of the tumor and type of treatment given. CONCLUSION: Radiation Therapy is an effective treatment for patients with vaginal carcinoma, particularly Stage I. More effective irradiation techniques, including optimization of dose distribution combining external irradiation and interstitial brachyTherapy in tumors beyond Stage I, are necessary to enhance locoregional tumor control. The high incidence of distant metastases emphasizes the need for earlier diagnosis and effective systemic cytotoxic agents to improve survival in these patients.
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irradiation alone or combined with surgery in stage ib iia and iib carcinoma of uterine cervix update of a nonrandomized comparison
International Journal of Radiation Oncology Biology Physics, 1995Co-Authors: Carlos A Perez, Andrew Galakatos, Perry W Grigsby, David G Mutch, H M Camel, Mary Ann LockettAbstract:Purpose: Definitive radiation Therapy alone or combined with surgery in carcinoma of the uterine cervix yields comparable tumor control and survival in Stages I and IIA when patients are adequately treated with either modality. Our 30-year institutional experience is described. Methods and Materials: This is a nonrandomized comparison of treatment results of 415 patients with Stage IB, 137 with Stage IIA, and 340 with Stage IIB carcinoma of the uterine cervix treated with irradiation alone and 197 with Stage IB, 44 with Stage IIA, and 65 with limited Stage IIB treated with pre- or postoperative irradiation and surgery. Irradiation alone consisted of a combination of external beam Therapy and Intracavitary insertions to deliver doses of 70 to 85 Gy to point A for patients with Stages IB and IIA disease and 80 to 90 Gy for patients with bulky or Stage IIB tumors. For patients treated with irradiation and surgery, various combinations of external beam and Intracavitary Therapy were used to deliver 60 to 75 Gy to point A. Surgical procedures consisted of radical hysterectomy with or without lymph node dissection in 130 patients with Stage IB, 28 patients with Stage IIA, and 10 patients with limited Stage IIB. Fifty-seven patients had total abdominal or conservative hysterectomy with or without lymph node dissection, and 3 had vaginal hysterectomy. In addition, 51 patients with Stage IIB tumors underwent pelvic lymphadenectomy after definitive irradiation. Results: The 5-year cause-specific survival (CSS) rates for patients with Stage IB nonbulky tumors treated with irradiation alone or irradiation combined with surgery were 90 and 85%, respectively, and the 10-year survival rate was 84% with either modality. In patients with bulky tumors (> 5 cm), the 5-year CSS rates were 61% with irradiation alone and 63% with irradiation plus surgery; at 10 years the rates were 61 and 68%, respectively (p = 0.5). For those with Stage IIA nonbulky tumors, the 5-year CSS rates were 75% with irradiation alone and 83% with combined irradiation and surgery, and 10-year CSS rates were 66 and 71%, respectively. In patients with Stage IIA bulky tumors, the 5-year CSS rates were 69% with irradiation alone and 60% with irradiation plus surgery, and at 10 years, 69 and 44%, respectively (p = 0.05). In patients with Stage IIB nonbulky tumors treated with irradiation alone or combined with surgery, the 5- and 10-year CCS rates were 72 and 65%, respectively; the corresponding survival rates with bulky tumors or bilateral parametrial involvement were 56 and 50%. Incidence of pelvic failures, alone or with distant metastasis, for Stage IB was 10% (43 out of 415) with irradiation alone and 14% (28 of 197) with irradiation plus surgery; for Stage IIA, 17% (23 out of 137) with irradiation alone and 20% (9 out of 44) with irradiation plus surgery; and for Stage IIB, 23% (88 out of 391) with irradiation alone and 29% (4 out of 14) with irradiation plus surgery. Grade 3 sequelae were comparable in both groups (irradiation alone, 5% to 11%; irradiation combined with surgery, 8% to 12%); the differences are not statistically significant. The most frequent major sequelae in 892 patients receiving irradiation only were rectovaginal fistula (13 cases, 1.5%), proctitis (10, 1.1%), small bowel obstruction (16, 1.8%), ureteral stricture (16, 1.8%), and vesicovaginal fistula (8, 0.9%). In 306 patients treated with irradiation plus surgery, the most commonly recorded major sequelae were small bowel obstruction/perforation (13 cases, 4.2%), ureteral stricture (8, 2.6%), vesicovaginal fistula (5. 1.6%), and rectovaginal fistula (4, 1.3%). Conclusion: Irradiation alone or combined with surgery yields comparable pelvic tumor control, survival, and morbidity in patients with Stage IB, IIA, and limited IIB carcinoma of the uterine cervix.
Carlos A Perez - One of the best experts on this subject based on the ideXlab platform.
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factors affecting long term outcome of irradiation in carcinoma of the vagina
International Journal of Radiation Oncology Biology Physics, 1999Co-Authors: Carlos A Perez, Perry W Grigsby, M Garipagaoglu, David G Mutch, Mary Ann LockettAbstract:OBJECTIVE: This report evaluates prognostic and technical factors affecting outcome of patients with primary carcinoma of the vagina treated with definitive radiation Therapy. METHODS AND MATERIALS: A retrospective analysis was performed on records of 212 patients with histologically confirmed carcinoma of the vagina treated with irradiation. RESULTS: Tumor stage was the most significant prognostic factor; actuarial 10-year disease-free survival was 94% for Stage 0 (20 patients), 80% for Stage I (59 patients), 55% for Stage IIA (63 patients), 35% for Stage IIB (34 patients), 38% for Stage III (20 patients), and 0% for Stage IV (15 patients). All in situ lesions except one were controlled with Intracavitary Therapy. Of the patients with Stage I disease, 86% showed no evidence of vaginal or pelvic recurrence; most of them received interstitial or Intracavitary Therapy or both, and the addition of external-beam irradiation did not significantly increase survival or tumor control. In Stage IIA (paravaginal extension) and IIB (parametrial involvement) 66% and 56% of the tumors, respectively, were controlled with a combination of brachyTherapy and external-beam irradiation; 13 of 20 (65%) Stage III tumors were controlled in the pelvis. Four patients with Stage IV disease (27%) had no recurrence in the pelvis. The total incidence of distant metastases was 13% in Stage I, 30% in Stage IIA, 52% in Stage IIB, 50% in Stage III, and 47% in Stage IV. The dose of irradiation delivered to the primary tumor or the parametrial extension was of relative importance in achieving successful results. In patients with Stage I disease, brachyTherapy alone achieved the same local tumor control (80-100%) as in patients receiving external pelvic irradiation (78-100%) as well. In Stage II and III there was a trend toward better tumor control (57-80%) with combined external irradiation and brachyTherapy than with the latter alone (33-50%) (p = 0.42). The incidence of grade 2-3 complications (12%) correlated with the stage of the tumor and type of treatment given. CONCLUSION: Radiation Therapy is an effective treatment for patients with vaginal carcinoma, particularly Stage I. More effective irradiation techniques, including optimization of dose distribution combining external irradiation and interstitial brachyTherapy in tumors beyond Stage I, are necessary to enhance locoregional tumor control. The high incidence of distant metastases emphasizes the need for earlier diagnosis and effective systemic cytotoxic agents to improve survival in these patients.
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irradiation alone or combined with surgery in stage ib iia and iib carcinoma of uterine cervix update of a nonrandomized comparison
International Journal of Radiation Oncology Biology Physics, 1995Co-Authors: Carlos A Perez, Andrew Galakatos, Perry W Grigsby, David G Mutch, H M Camel, Mary Ann LockettAbstract:Purpose: Definitive radiation Therapy alone or combined with surgery in carcinoma of the uterine cervix yields comparable tumor control and survival in Stages I and IIA when patients are adequately treated with either modality. Our 30-year institutional experience is described. Methods and Materials: This is a nonrandomized comparison of treatment results of 415 patients with Stage IB, 137 with Stage IIA, and 340 with Stage IIB carcinoma of the uterine cervix treated with irradiation alone and 197 with Stage IB, 44 with Stage IIA, and 65 with limited Stage IIB treated with pre- or postoperative irradiation and surgery. Irradiation alone consisted of a combination of external beam Therapy and Intracavitary insertions to deliver doses of 70 to 85 Gy to point A for patients with Stages IB and IIA disease and 80 to 90 Gy for patients with bulky or Stage IIB tumors. For patients treated with irradiation and surgery, various combinations of external beam and Intracavitary Therapy were used to deliver 60 to 75 Gy to point A. Surgical procedures consisted of radical hysterectomy with or without lymph node dissection in 130 patients with Stage IB, 28 patients with Stage IIA, and 10 patients with limited Stage IIB. Fifty-seven patients had total abdominal or conservative hysterectomy with or without lymph node dissection, and 3 had vaginal hysterectomy. In addition, 51 patients with Stage IIB tumors underwent pelvic lymphadenectomy after definitive irradiation. Results: The 5-year cause-specific survival (CSS) rates for patients with Stage IB nonbulky tumors treated with irradiation alone or irradiation combined with surgery were 90 and 85%, respectively, and the 10-year survival rate was 84% with either modality. In patients with bulky tumors (> 5 cm), the 5-year CSS rates were 61% with irradiation alone and 63% with irradiation plus surgery; at 10 years the rates were 61 and 68%, respectively (p = 0.5). For those with Stage IIA nonbulky tumors, the 5-year CSS rates were 75% with irradiation alone and 83% with combined irradiation and surgery, and 10-year CSS rates were 66 and 71%, respectively. In patients with Stage IIA bulky tumors, the 5-year CSS rates were 69% with irradiation alone and 60% with irradiation plus surgery, and at 10 years, 69 and 44%, respectively (p = 0.05). In patients with Stage IIB nonbulky tumors treated with irradiation alone or combined with surgery, the 5- and 10-year CCS rates were 72 and 65%, respectively; the corresponding survival rates with bulky tumors or bilateral parametrial involvement were 56 and 50%. Incidence of pelvic failures, alone or with distant metastasis, for Stage IB was 10% (43 out of 415) with irradiation alone and 14% (28 of 197) with irradiation plus surgery; for Stage IIA, 17% (23 out of 137) with irradiation alone and 20% (9 out of 44) with irradiation plus surgery; and for Stage IIB, 23% (88 out of 391) with irradiation alone and 29% (4 out of 14) with irradiation plus surgery. Grade 3 sequelae were comparable in both groups (irradiation alone, 5% to 11%; irradiation combined with surgery, 8% to 12%); the differences are not statistically significant. The most frequent major sequelae in 892 patients receiving irradiation only were rectovaginal fistula (13 cases, 1.5%), proctitis (10, 1.1%), small bowel obstruction (16, 1.8%), ureteral stricture (16, 1.8%), and vesicovaginal fistula (8, 0.9%). In 306 patients treated with irradiation plus surgery, the most commonly recorded major sequelae were small bowel obstruction/perforation (13 cases, 4.2%), ureteral stricture (8, 2.6%), vesicovaginal fistula (5. 1.6%), and rectovaginal fistula (4, 1.3%). Conclusion: Irradiation alone or combined with surgery yields comparable pelvic tumor control, survival, and morbidity in patients with Stage IB, IIA, and limited IIB carcinoma of the uterine cervix.
