Consequences on treatment outcome and late effects of customised treatment planning in cervix carcinomas

The aim of this study is to determine the predictive factors of complications using French-Italian Syllabus and to evaluate the impact of customised treatment planning policy (CTP) on G3 G4 complications rates per stage and time in correlation with disease-free-survival (DFS) and local-control (LC) rates. Material: From 1970 to 1994, 642 patients were treated with radiotherapy alone for intact uterine cervix carcinomas. 30% were staged I, 42% II and 28% III/IV. The analysis was divided in 3 periods: 1970-1978, 1979-1984, 1985-1994. Methods: Predictive factors were determined by univariate analysis using frequency tables and non parametric t-tests. Multivariate analysis consisted in a polychototomus stepwise regression. 5-year DFS and LC rates were calculated using Kaplan-Meieer method. Results: The comparison of the 3 time periods shows a significant reduction of 1 deg. ) external radiation dose ED (dose above 40 Gy 47% of patients before 1979 vs 36% after 1984) 2 deg.) the use of parametrium boost (55% vs 39%) 3 deg.) the HWT volume (842 cc3 vs 503 cc3 on average). Crude complications rates all stages all organs are: G1 23%, G2 19%, G3 6%, G4 3%. The 4 main predictive factors of occurrence of G1/G2 and G3/G4 rectal and bladder complications are period, increase of ED, high dose rate at reference points and brachytherapy to the whole vagina. No G4 occurred in the third period. G3 rates decreased with time dropping from 5% in the first period to 0% in the third period in stage I, from 10% to 6% in stage II and from 23% to 12% in stages III/IV. Meanwhile 5-year LC rates remain stable in early stages, about 91% in stage I and 85% in stage II, conversely they fall from 75% to 55% in stages III/IV, thus raising the problem of underdosage and/or improved staging with time. In summary: CTP eradicates lethal complications and provides significant decrease of G3 in all cases while maintaining high cure rates in early stages. Dose reduction should be considered with caution in stages III/IV