Cervical carcinoma: Changing trends in management

The most important improvement in the treatment of patients with invasive carcinoma of the uterine cervix during th elast decades can mainly be ascribed to the fact that most patients are nowadays diagnosed at an early stage. However, refinements of surgery and radiotherapy most certainly have decreased the morbidity of treatment; besides this, the optimal use of each modality as well as the combination of both methods may have led to some, albeit small, increase in curing rate. In this report the clinical experience in 472 patients is described. Since any improvement in results can only be achieved after a careful analysis of failures, special attention is paid to the pattern of recurrence. In stage IB or IIA with proven absence of pelvic lymph node metastases, prognosis is excellent. In case of pelvic metastases, however, prognosis is rather bad, especially if more than one grup of lymph nodes is involved. Since many recurrences in this group are still confined to the para-aortic region, some improvement is to be expected by extending the postoperative irradiation field to the para-aortic lymph nodes. With advancing stage or larger tumor volume, the relative chance of intrapelvic recurrence increases. In this category of patients, all efforts should be directed to optimize locoregional treatment; the use of radiosensitizing agents and especially the combination of cytostatics followed by radiotherapy may be useful. Extension of the treatment to the paraaortic nodes is only worthwhile in case of initial favourable response of the primary tumor. (orig.)