title: Patterns of failure of bulky-barrel carcinomas of the cervix.
abstract: OBJECTIVE
  This retrospective study was conducted to analyze the hypothesis that radiation therapy followed by extrafascial hysterectomy would improve survival in patients with bulky-barrel cervical carcinomas.
  
  
  METHODS
  Forty-three patients with bulky-barrel carcinomas of the cervix were treated over a 14-year period. The majority of these were treated with approximately 4000 cGY external beam, followed by brachytherapy, followed by extrafascial hysterectomy.
  
  
  RESULTS
  Forty-seven percent of all patients are dead of disease; 2.3% are alive with disease. Of the total patients, 35% had diseased paraaortic nodes, and 80% of these are dead of disease. Of the patients dead of disease, 80% had distant metastases. Delayed complications included: vesicovaginal fistulas (n = 3), surgery for bowel obstruction (n = 3), rectovaginal fistula (n = 1), and vaginal vault necrosis (n = 3).
  
  
  CONCLUSIONS
  These data do not support an improvement in survival of patients with bulky-barrel-shaped lesions treated with irradiation plus adjunctive hysterectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta.
authors.forename: D L
authors.initials: DL
authors.lastname: Coleman
authors.forename: D G
authors.initials: DG
authors.lastname: Gallup
authors.forename: H D
authors.initials: HD
authors.lastname: Wolcott
authors.forename: L B
authors.initials: LB
authors.lastname: Otken
authors.forename: R J
authors.initials: RJ
authors.lastname: Stock
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D014626:Vaginal Smears