title: Clinical assessment by MRI for patients with stage II cervical carcinoma treated by radiation alone in multicenter analysis: are all patients with stage II disease suitable candidates for chemoradiotherapy?
abstract: OBJECTIVE
  From recent randomized trials, patients with Stage II cervical carcinoma are thought to be candidates for chemoradiotherapy. To refine the strategy for Stage II patients, we performed a retrospective multi-institutional analysis using MRI.
  
  
  METHODS
  From three institutions, 84 patients with Stage II cancer diagnosed by MRI were entered into the study. All patients received intracavitary brachytherapy with (n = 83) or without (n = 1) external beam radiotherapy. Uni- and multivariate analyses were performed to identify the prognostic factors for overall survival (OAS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS).
  
  
  RESULTS
  The 5-year DFS rate of patients with maximal tumor size (D(max)) > or =50 mm (46.2%) was significantly lower than that for patients with D(max) <50 mm (88.0%; p <0.0001). Large size or volume and lymph node swelling were also significant prognostic factors of OAS, DFS, PC, and DMFS. In the multivariate model, size or volume was a significant prognostic factor of OAS, DFS, PC, and DMFS, and lymph node swelling was a prognostic factor for DFS, PC, and DMFS. Using these two prognostic factors, patients were divided into 3 subgroups. The 5-year DFS rate of patients with risk 0 (D(max) <50 mm and negative lymph node swelling), 1 (D(max) > or =50 mm or positive lymph node swelling), and 2 (D(max) > or =50 mm and positive lymph nodes) was 93.2%, 53.3%, and 25.0%, respectively (p <0.0001).
  
  
  CONCLUSIONS
  In this stage-limiting analysis, we clarified the stratification according to clinical risk with the aid of MRI. For patients with low-risk factors, especially for elderly patients, radiation alone would probability be a feasible option. In the future, a randomized trial using criteria with MRI would help to identify the optimal strategy for patients with Stage II disease.
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center, Aichi, Japan. yra05712@nifty.ne.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
authors.forename: Minoru
authors.initials: M
authors.lastname: Kamata
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Furutani
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kuzuya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sasaoka
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Nomoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy* / Q000556:secondary; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008199:Lymphadenitis / Q000150:complications; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D011832:Radiation Injuries / Q000150:complications; D012002:Rectal Diseases / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents