RADIOTHERAPY FOR CARCINOMA OF THE UTERINE CERVIX USING LOW-DOSE-RATE INTRACAVITARY BRACHYTHERAPY: A RETROSPECTIVE ANALYSIS OF PRETREATMENT AND TREATMENT PROGNOSTIC FACTORS

Purpose: To assess treatment outcome of radiotherapy using low-dose-rate brachytherapy for carcinoma of the uterine cervix, a retrospective analysis of 727 patients was carried out. Methods: We calculated the survival rate and incidence of late complications, and then evaluated the prognostic factors about clinico-pathological data and treatment methods using univariate and multivariate analyses. In particular, we assessed a chemotherapy administered concurrently with radiotherapy for locally advanced cervical cancer (stage IIB, III, IVA). Results: The 5-year overall survival rate was 83% in Stage I, 76% in Stage II, 57% in Stage III, 44% in Stage IVa and 14% in Stage IVb respectively. Five-year overall survival rate for locally advanced cervical cancer was 62% for those treated with radiotherapy alone, 57% with systemic chemotherapy, 69% with intra-arterial chemotherapy. No significant differences between groups were observed. Results of the multivariate analysis revealed that clinical stage was the only independent prognostic variable. Severe (grade 3) complications occurred in 4.4% of all patients. A definite correlation was observed between the severity of rectosigmoidal complications and radiation dose. In the group with intra-arterial chemotherapy, high grade (grade 2-3) complications ocurred in 52%. Conclusions: Clinical stage was the only independent prognostic factor, and the adjuvant therapy assessed in the present study did not improve the prognosis retrospectively. Adverse effects were within allowable range, but a combination of intra-arterial chemotherapy has the added potential to increase high-grade late complications.