Radiotherapy for cervical cancer patients

Two hundred sixty six cervical cancer patients with histologically proven squamous cell carcinoma were treated with radiotherapy alone at Keio University Hospital between September 1984 and March 1991. All patients received 30 Gy of external whole pelvic irradiation and 20 Gy of pelvic irradiation with the central shield. After 30 Gy of whole pelvic irradiation, high dose rate intracavitary brachytherapy (20-30 Gy) was applied with the shielded coplostats (3 mm lead). The survival rate in each stage gradiently decreased with the advance of the stage. When patients with stage III cervical cancer were classified into three groups according to the tumor sizes (S, M, L), patients in group L had the worst survival rate. At follow-up visits conducted between 1 and 2 months after completion of radiation, patients in stage III L had significantly higher rate of persistent disease and recurrence. There was no correlation between the incidence of rectosigmoid sequelae and doses by brachytherapy, and shielded colpostats could not decrease the incidence of rectosigmoid sequelae, compared with the unshielded colpostats. However, the shielded colpostats could significantly decrease the severe complications (grade 3). This result suggests that more irradiation dose is necessary to control the local tumor in stage III L patients and additional doses by brachytherapy (6 Gy) with shielded colpostats may not increase the incidence of severe rectosigmoid sequelae. (author)