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High-dose rate intracavitary irradiation for carcinoma of the uterine cervix

Nachteiliger Effekt bei Verlängerung der Behandlungszeit in der Therapie des Zervixkarzinoms

The adverse effect of treatment prolongation

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Abstract

Aim

To investigate the adverse effect of treatment prolongation on the local control and survival of the cervical carcinoma of the uterus.

Patients and Method

Two hundred and sixteen patients with stages IIB and III cervical carcinoma treated with a combination of external radiation and high-dose rate (HDR) intracavitary irradiation between 1978 and 1989 were retrospectively studied. A multivariate analysis was used to determine the effect of treatment time on local control and survival.

Results

Overall treatment time was the most highly significant factors for local control in the multivariate analysis (p=0.0005). The 5-year cumulative relapse rates were significantly different with the treatment times 35 to 42 days: 9% versus 43 to 49 days: 19% versus 50 to 62 days: 42% (p=0.001). The second most significant parameter was stage classification (p=0.02). Concerning relapse-free survival, stage classification (p=0.0001), overall treatment time (p=0.0035) and hemoglobin level (p=0.0174) were the 3 most important prognostic factors, although there was no relationship between treatment time and late complications.

Conclusion

These results suggest that prolongation of treatment time is associated with decreased local control and survival in patients treated with external radiation and HDR intracavitary irradiation.

Zusammenfassung

Ziel

Untersuchung der Wirkung einer Verlängerung der Behandlungszeit auf lokale Tumorkontrolle und Überleben beim Zervixkarzinom.

Patienten und Methode

Von 1978 bis 1989 wurden 216 Frauen mit Zervixkarzinom im Stadium IIB-III kombiniert perkutan und intrakavitär mit HDR-Brachytherapie bestrahlt und retrospektiv untersucht. Mittels multivariater Analyse wurde der Effekt der Behandlungszeit auf die lokale Tumorkontrolle und das Überleben untersucht

Ergebnisse

In multivariater Analyse war die Gesamtbehandlungszeit der signifikanteste Prognosefaktor für die lokale Tumorkontrolle (p=0,0005). Die kumulative Fünf-Jahres-Rezidivrate wies für jeweils verschiedene Behandlungszeiten signifikante Unterschiede auf: bei 35 bis 42 Tagen 9%, bei 43 bis 49 Tagen 19% und bei 50 bis 62 Tagen 42% (p=0,001). Der nächstwichtigste Prognosefaktor war das Tumorstadium (p=0,02). Bezüglich des rezidivfreien Überlebens waren Tumorstadium (p=0,0001), Gesamtbehandlungszeit (p=0,0035) und Hb-Level (p=0,0174) die wichtigsten Prognosefaktoren. Im Gegensatz dazu ergab sich kein Zusammenhang zwischen Behandlungszeit und Spätfolgen.

Schlußfolgerung

Eine Verlängerung der Gesamtbehandlungszeit vermindert die lokale Tumorkontrollrate und die Überlebensrate bei kombinierter externer und intrakavitärer Radiotherapie.

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Authors and Affiliations

  1. Department of Radiation Therapy, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3 Nakamichi 1-Chome Higashinari-ku, 537, Osaka, Japan

    M. Chatani, Y. Matayoshi & N. Masaki

  2. Department of Radiation Oncology, Biomedical Research Center, Osaka University Medical School, Osaka, Japan

    T. Inoue

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  1. M. Chatani
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  2. Y. Matayoshi
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  3. N. Masaki
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  4. T. Inoue
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Chatani, M., Matayoshi, Y., Masaki, N. et al. High-dose rate intracavitary irradiation for carcinoma of the uterine cervix. Strahlenther. Onkol. 173, 379–384 (1997). https://doi.org/10.1007/BF03038241

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