title: Definitive radiotherapy combined with high-dose-rate brachytherapy for Stage III carcinoma of the uterine cervix: retrospective analysis of prognostic factors concerning patient characteristics and treatment parameters.
abstract: OBJECTIVE
  To assess treatment outcome after definitive radiotherapy for Stage III cervical carcinoma retrospective analysis of the clinical data was performed.
  
  
  METHODS
  We enrolled 265 patients with Stage III cervical carcinoma who were treated with combined external beam radiotherapy [mean +/- standard deviation (SD), 50.3 +/- 1.8 Gy; range 40-70) and intracavitary brachytherapy (ICBT) (mean +/- SD, 19.8 +/- 2.4 Gy; range 10-32) using a high-dose-rate 60Co source. We retrospectively analyzed, as measures of the therapeutic outcome, the overall survival rate (OAS), relapse-free survival rate (RFS), locoregional event-free rate (LREF), distant metastasis (DM), and late complication.
  
  
  RESULTS
  The 5-year OAS, RFS, and LREF rates (n = 265) were 50.7%, 57.1%, and 71.2%, respectively. Univariate analysis revealed a significant favorable effect on the OAS rate for complete response (CR) (p = 0.024), maximum tumor diameter < 6 cm (SML) (p = 0.0009), Karnofsky performance score > or =70 (p = 0.046), age <75 years (p = 0.0043), hemoglobin (Hb) concentration of > or =9 g/dl (p = 0.0005), and histopathological diagnosis of squamous cell carcinoma (SCC) (p = 0.0089). In the multivariate analysis, Hb, SCC, SML, and CR remained significant prognostic factors. In both univariate and multivariate analysis, SML, Hb, age, and SCC showed significant effects on the RFS rate. Age > or =60 years (p = 0.017), Hb > or =9 g/dl (p = 0.0039), and SML (p = 0.0046) were significant favorable prognostic factors for the LREF rate identified by univariate analysis. In addition, advanced age, SML, and SCC showed significant beneficial effects on the LREF rate in the multivariate analysis. DM developed in 21.1% of patients, and the groups with Hb < 9 g/dl (p < 0.005), Karnofsky performance score of <70 (p < 0.001), and dose at point A in the ICBT < 16 Gy (p < 0.005) developed a significantly greater incidence of DM than did the groups without. The 5-year incidence was 2.6% for major bladder complication and 8.3% for major rectal complication. The radiation dose in the subgroup with rectal complication was significantly greater than that in the subgroup without complications.
  
  
  CONCLUSIONS
  In patients with Stage III cervical carcinoma, tumor size, concentration of Hb, and histopathological diagnosis are strong prognostic factors for the therapeutic outcome. The ICBT dose in our study was small compared to the reported data, but the outcome was quite comparable. Thus, the dose we used might be the minimum required. However, locoregional control still remains an important problem. It is necessary to attain the optimal dose distribution in both the target volume and in critical organs. In high-risk patients, combined use of chemotherapy is crucial to improve the response to radiation.
authors.affiliation: Department of Therapeutic Radiology, Tokyo Metropolitan Komagome Hospital, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takeshi
authors.forename: K
authors.initials: K
authors.lastname: Katsuyuki
authors.forename: T
authors.initials: T
authors.lastname: Yoshiaki
authors.forename: S
authors.initials: S
authors.lastname: Teppei
authors.forename: M
authors.initials: M
authors.lastname: Tadayoshi
authors.forename: M
authors.initials: M
authors.lastname: Akira
authors.forename: M
authors.initials: M
authors.lastname: Katsumi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001918:Brachytherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*