title: The adverse effect of treatment prolongation in cervical carcinoma.
abstract: OBJECTIVE
  Proliferation of surviving tumor clonogens during a course of protracted radiation therapy may be a cause of local failure in cervical carcinoma. The effect of total treatment time was analyzed retrospectively in relation to pelvic control and overall survival for squamous cell carcinomas of the uterine cervix.
  
  
  METHODS
  Two hundred and nine patients (Stage IB-IIIB) treated with a combination of external beam and low dose rate intracavitary irradiation were evaluable for study. Multivariate analysis and Kaplan-Meier statistical methods were used to determine the effect of treatment time on pelvic control and survival at 5 years.
  
  
  RESULTS
  The median treatment duration was 55 days. For all stages combined, the 5-year survival and pelvic control rates were significantly different with treatment times < 55 days vs. > or = 55 days: 65 and 54% (p = 0.03), 87 and 72% (p = 0.006), respectively. By stage, a shorter treatment duration (i.e., < 55 days vs. > or = 55 days) was significant for 5-year overall survival and pelvic control for Stages IB/IIA and III, but not for Stage IIB: Stage IB/IIA (81 and 67%, 96 and 84%), Stage III disease (52 and 42%, 76 and 55%) and Stage IIB (43 and 50%, 74 and 80%, respectively). Survival decreased 0.6%/day and pelvic control decreased 0.7%/day for each additional day of treatment beyond 55 days for all stages of disease. Additionally, significant late complications were not influenced by treatment time.
  
  
  CONCLUSIONS
  These results suggest that prolongation of treatment time is associated with decreased local control and survival in patients with cervical carcinoma. This is consistent with emerging data from other institutions. Therapeutic implications include avoidance of unnecessary treatment breaks, the design of fractionation schemes that decrease treatment duration, and possibly the use of tumor cytostatic drugs during conventional radiation.
authors.affiliation: Department of Human Oncology, University of Wisconsin Medical School, Madison, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Petereit
authors.forename: J N
authors.initials: JN
authors.lastname: Sarkaria
authors.forename: R
authors.initials: R
authors.lastname: Chappell
authors.forename: J F
authors.initials: JF
authors.lastname: Fowler
authors.forename: T J
authors.initials: TJ
authors.lastname: Hartmann
authors.forename: T J
authors.initials: TJ
authors.lastname: Kinsella
authors.forename: J A
authors.initials: JA
authors.lastname: Stitt
authors.forename: B R
authors.initials: BR
authors.lastname: Thomadsen
authors.forename: D A
authors.initials: DA
authors.lastname: Buchler
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D015996:Survival Rate; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology