The comparison of treatment results in cervical cancer stage IIIB patients using different radiation techniques
Affiliation and adress for correspondence

1 Klinika Nowotworów Narządów Płciowych Kobiecych. Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie.
Kierownik: doc. dr hab. med. M. Bidziński
2 Klinika Położnictwa i Ginekologii. Instytut Matki i Dziecka w Warszawie.
Kierownik: doc. dr hab. med. K. Niemiec
Correspondence to: Ryszard Krynicki, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie, Klinika Nowotworów Narządów Płciowych Kobiecych, ul. Roentgena 5, 02-781 Warszawa, tel.: (0*22) 546 23 96.
Source of financing: Department own sources

GIN ONKOL, 2005, 3 (2), p. 106-113
ABSTRACT

Introduction: Radiation plays a major role in the management of gynaecological malignancies. Usually, the treatment involves the combination of external-beam and intracavitary irradiation. The external-beam radiation therapy causes the shrink of tumour mass and delivers the conditions to brachytherapy at the same time. The tumour geometry improvement enables the optimal dose distribution during brachytherapy. In the cases where the conditions to brachytherapy are not obtained, the external-beam irradiation is continued, limited only to the area of genital organ with the tumour. The aim of this paper: The comparison of treatment results of advanced cervical cancer depending on the radiation techniques used (external-beam irradiation only vs combination of external-beam and intracavitary radiation), as well as the analysis of factors influencing on survivals. Material and method: The analysis involved 387 patients with cervical cancer stage IIIB, treated with radiotherapy in the Department of Gynaecological Oncology, Memorial Cancer Centre, Warsaw. All patients had external-beam irradiation up to the dose of 44-50 Gy as the first step of treatment. Brachytherapy was conducted in 246 (64%) patients. The dose of 45 Gy was delivered to the point A. In the remaining group of 141 (36%) patients, the external-beam irradiation was continued to the total dose of 54-62 Gy. Results: The significantly worse survivals were obtained in the group of patients, who were irradiated from external fields only, without brachytherapy. The 5-years survivals were 31% and 56%, respectively. Moreover, the factors significantly influencing on survivals appeared to be: total dose (p=0.00285), tumour size (p=0.00594), haemoglobin level (p=0.00042), patients general condition (p=0.045) and concomitant coronary heart disease (p=0.034). Conclusions: The total dose delivered to the tumour shows the determining effect on the radiation treatment results in cervical cancer. In patients with no optimal conditions to brachytherapy obtained, the dose should be increased with using conformal radiotherapy, up to the values on the level acceptable for the risk of late radiation-induced complications.

Keywords: cervical cancer, external-beam radiotherapy, brachytherapy, boost, the treatment results