2351: Outcome Following Radiotherapy for Stage IIIB and IVA Cervix Cancer

Abstract

To report the long-term outcome following radiotherapy with curative intent for stage IIIB and IVA carcinoma of the cervix. This is a retrospective review of 91 consecutive patients treated with radiotherapy with curative intent at the University of Florida between January 1980 and December 2003 for stage IIIB (84 patients) or IVA (7 patients) carcinoma of the cervix. All 91 patients were treated with a combination of external beam radiotherapy delivered to a median dose of 60 Gy (range, 40 to 70.3 Gy) to the pelvis and low-dose rate brachytherapy. Patients were treated with either one ∼72 hour implant (68%) or two ∼48 hour implants (32%). The implants were either interstitial, intracavitary, or a combination of the two depending on the patient’s anatomy. Thirty-three patients (36%) received at least one interstitial implant either alone or in combination with an intracavitary implant. The median dose from the interstitial implants was 27.6 Gy to the periphery of the implant. The remaining 64% of patients received only intracavitary implants. The median dose from the intracavitary implants was 25.1 Gy to Point A. Chemotherapy was delivered to 13 patients (14%). The median follow-up for surviving patients was 8.8 years. The 5- and 10-year Kaplan-Meier estimates of local control, regional control, locoregional control, relapse-free survival, and overall survival were 53% and 53%, 55% and 47%, 34% and 29%, 30% and 26%, and 29% and 21%, respectively. Ninety percent of recurrences were detected within 2 years after treatment. The pattern of failure was as follows: 60% of all failures were local (+/- regional or distant recurrence), 29% were regional (pelvic and/or para-aortic nodes +/- distant recurrence), and 11% were distant failures alone. Seventeen percent of the failures were in the para-aortic nodes (+/- distant sites) with no evidence of failure in the pelvis. Our data suggested that elective irradiation of the para-aortic nodes decreased failures in the para-aortic nodes (0% for patients who received elective para-aortic irradiation vs. 13% for patients who did not), but this difference was not statistically significant. A wide range of demographic, treatment, and technical factors were evaluated with univariate and multivariate analysis with the endpoint being relapse-free or overall survival. No factor was found to be statistically significant. Therapy complications were scored using the RTOG grading system; the overall severe late complication rate was 13% (grades 3–5). This series is one of the most mature in the literature. With long-term follow-up, approximately one-third of patients with stage IIIB or IVA cervix cancer are cured with a 15% complication rate. Our series demonstrates what can be achieved without chemotherapy since 86% of the patients were treated with radiotherapy alone. As long-term results become available, it will be important to compare our results to those from series with combined modality therapy.