Results of radiotherapy alone in the treatment of advanced cervix carcinoma

A study has been made on 429 cases of advanced stage carcinoma of the uterine cervix treated with radiotherapy alone in the years 1971/85 (105 Stage II-distal, 24.5%, 315 Stage III, 73.4%, 9 Stage IVa, 2.1%). 2 and 5-year relapse free survival (RFS) was respectively 56.3% and 48.1% for all the patients considered, with the exception of the 9 initially stage IVa cases. In the initially Stage II-distal cases, RFS was respectively 72.3% and 59.1% and, in initially stage III cases, respectively 50.1% and 43.1%. None of the Stage IVa patients survived without relapse beyond two years from the treatment. The most frequent failure cause was lack of pelvic control, mainly alone or, more seldom, in association with distant metastasis. In the years 1980/85, 168 patients (39.2%) were submitted to irradiation techniques conforming with the modern requirements of radiotherapy of cervical cancer (whole pelvis external irradiation with high power megavoltage machines plus central boost with remote-loading curietherapy). There was a considerable improvement in the results for the Stage II-distal cases. The 5-year NED survival was 66.5%, with respect to the 52.0% observed for the cases treated in the years 1971/79. Lack of pelvic control was reduced by about 1/3, and the number of pelvic relapses with central recurrence was more than halved. On the contrary, a minimum improvement was achieved for Stage III. RFS remained unaltered around 50% at 5 years, the lack of pelvic control was only slightly reduced and the number of pelvic relapses with central recurrence was unchanged. Radiotherapy is still the basic treatment for advanced stage cervical carcinoma. The classical methods to improve its results (irradiation in hyperbarism, hyperthermia, high LET radiations, radiosensitizers, interstitial parametrial implants) have not produced convincing results up to now, or are still at a preliminary study phase. Attention is now drawn to the addition of chemotherapy given prior to radiotherapy (neoadjuvant chemotherapy) or in strict synchronization (concurrent chemo-radiotherapy).