title: Tumor heterogeneity of FIGO stage III carcinoma of the uterine cervix.
abstract: OBJECTIVE
  The purpose of this study was to analyze tumor heterogeneity based on tumor extent and suggest reappraisal of the system of the International Federation of Gynecology and Obstetrics (FIGO) for Stage III carcinoma of the uterine cervix from a radiotherapeutic viewpoint.
  
  
  METHODS
  Between 1986 and 2004, 407 patients with FIGO Stage III (FIGO Stage IIIa in 19 and IIIb in 388) were treated with external beam radiotherapy (RT) and high-dose rate brachytherapy. All patients were reviewed with respect to tumor extent. Patterns of failure and survival parameters were analyzed by use of the chi(2) test and Kaplan-Meier method.
  
  
  RESULTS
  The complete response rate was 79.6%, and the 5-year overall survival rates for Stage IIIa and Stage IIIb carcinoma of the cervix were 82.1% and 54.8%, respectively. To determine which parameters of tumor extent had an influence on prognosis for Stage IIIb patients, pelvic wall (PW) extension and hydronephrosis (HD) retained significance on multivariate analysis. Stage IIIb patients were divided into three subgroups according to PW extension and HD: low risk (unilateral PW extension without HD), intermediate risk (HD without PW extension or bilateral PW extension without HD), and high risk (unilateral or bilateral PW extension with HD). The high-risk group had a remarkably low complete response rate, high locoregional failure rate, and low 5-year survival rate compared with the intermediate- and low-risk groups.
  
  
  CONCLUSIONS
  FIGO Stage III carcinoma of the cervix covers considerably heterogeneous subgroups according to tumor extent. Before initiation of treatment, we suggest that physicians determine a tailored treatment policy based on tumor heterogeneity for each Stage III patient.
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.forename: Ik Jae
authors.initials: IJ
authors.lastname: Lee
authors.forename: Song Yih
authors.initials: SY
authors.lastname: Kim
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Hong In
authors.initials: HI
authors.lastname: Yoon
authors.forename: Sang Wun
authors.initials: SW
authors.lastname: Kim
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Kim
authors.forename: Young Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Chang Ok
authors.initials: CO
authors.lastname: Suh
authors.forename: Gwi Eon
authors.initials: GE
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy