Altered fractionation and extended-field irradiation of carcinoma of the cervix.
Conventional radiotherapy for treatment of carcinoma of the cervix consists of five daily fractions of 1.80-2.00 Gy, 5 days/week, up to 40.00-50.00 Gy, followed by intracavitary brachytherapy to complete a paracentral dose ranging from 70 to 90 Gy and a lateral pelvic wall dose ranging from 50 to 60 Gy. This results in tumor control in the pelvis for at least 91% of patients with Stage IB disease. However, survival rates at 5-year follow-up have ranged from 49% to 69% for patients with Stage III disease and 25% to 34% for patients with Stage IVA disease. Attempts to improve clinical results for patients with more advanced stages of disease have included hypofractionated and hyperfractionated radiotherapy, accelerated fractionation, and concomitant boost. However, no improvement of tumor control or survival has been obtained. Hyperfractionated external pelvic radiation remains undefined as a method of improving results. Extended-field prophylactic irradiation of the paraaortic lymph nodes has shown significant value in a study group setting. Early diagnosis and prevention continue to be the most promising approaches in the control of carcinoma of the cervix.
Marcial
V A
VA
Radiotherapy Center, Metropolitan Hospital, San Juan, Puerto Rico 00922.
Komaki
R
R
D005260:Female; D006801:Humans; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*