title: [Large volume stage I and II epidermoid carcinoma of the uterine cervix treated with primary radiotherapy and surgery].
abstract: Fifty-two women with stage Ib2 and II bulky squamous cell carcinoma of the uterine cervix (mean size: 5.65 +/- 0.12 cm, range: 5-8 cm) were treated between July 1982 and December 1993. The median follow-up was 73 months. Their patient's age ranged from 25 to 77 years (median: 45 years). There were 18 stage Ib2, 8 stage IIa and 26 stage IIb operable patients. External radiotherapy was delivered using photons of 6 MV to 25 MV and a four-field "box" technique (upper limit situated between L4-L5). Mean total dose at mid-plane to the whole pelvis was 38.6 Gy (range: 37.4-40.6 Gy) in 18 fractions over 30 days. A boost dose of 20 Gy was given by intracavitary brachytherapy (utero-vaginal). After a mean rest of 48 days, total abdominal hysterectomy and bilateral salpingo-oophorectomy combined with bilateral pelvic lymphadenectomy was performed. Following surgery, no remaining tumor on pathological examination of uterine cervix was observed in 39 cases (75%) and positive external iliac nodes were found in 4 cases. Five- and 10-year specific survival rates were 80% and 75%, respectively. The 5- year local tumour recurrence and nodal recurrence rates were 18% and 15%, respectively. There were 7 para-aortic nodal recurrences (3 were isolated para-aortic nodal relapses). There were five late severe complications necessiting surgical intervention. A combination of preoperative radiation therapy and concomitant chemotherapy, and the extended dissection of common iliac and para-aortic lymph nodes or a post operative prophylactic extended field irradiation including para-aortic lymph nodes is now being attempted in order to improve the locoregional tumour and para-aortic lymph node control rates.
authors.affiliation: Service d'Oncologie-Radiothérapie, Hôpital Tenon, Paris.
authors.forename: E
authors.initials: E
authors.lastname: Touboul
authors.forename: J P
authors.initials: JP
authors.lastname: Lefranc
authors.forename: Y
authors.initials: Y
authors.lastname: Belkacémi
authors.forename: A
authors.initials: A
authors.lastname: Rogel
authors.forename: F
authors.initials: F
authors.lastname: Deluen
authors.forename: J
authors.initials: J
authors.lastname: Blondon
authors.forename: M
authors.initials: M
authors.lastname: Housset
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010052:Ovariectomy; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*
vernacular_title: Carcinomes épidermoïdes du col utérin stades I et II de gros volume traités par radiothérapie première et chirurgie.