Causes, time of death, and sites of failure in squamous-cell carcinoma of the uterine cervix on intact uterus.

Abstract

There is a considerable literature on five-year survival rates in patients with cancer of the uterine cervix who have been treated by radiations, surgery, or a combination of both. Reports on long-term follow-ups are few. Those from the Radiumhemmet (1) and Radium Centre in Copenhagen (8) are on patients treated prior to World War II. The purpose of this essay is to study the time distribution and causes of death (active disease, complications, intercurrent disease), as well as the sites of active disease at the time of death in 2,220 patients treated at The University of Texas M. D. Anderson Hospital and Tumor Institute from Sept. 1, 1948, through Dec. 31, 1963, for squamous-cell carcinoma of the uterine cervix on intact uterus. Of those 2,220 patients, 965 are known to be dead. In addition to this broad statistical review, specific aspects of the disease will be discussed, as will some sites of recurrent disease. Modalities of Treatment At the M. D. Anderson Hospital and Tumor Institute, irradiation has been almost the exclusive treatment for all patients with invasive squamous-cell carcinoma of the intact uterus. From September 1948 through 1953, only kilovoltage was available, but in 1954, a Co60 unit and a 22-MeV betatron unit were installed. During that year the technic of whole-pelvis irradiation was developed primarily with the 22 MeV betatron. From approximately Sept. 1, 1954, all patients with whole-pelvis irradiation have been treated with that equipment. Through 1955, parametrial irradiation was also gradually shifted to the 22 MeV betatron. The policies of treatment and the technics have been described in detail (5), survival rates reported (4), and the complications of megavoltage irradiation analyzed for patients treated up to February 1959 (3). The recurrence times for tumors in Stages IIB, IIIA, and IIIB managed with the 22 MeV betatron have been the subject of special study (9). From 1955 through 1959, an extensive program of lymphadenectomy was carried out after full irradiation in unselected patients. The results have been reported elsewhere (7). Later, a program of added conservative hysterectomy was initiated for selected patients, primarily those with Stage IIB disease. The results have not yet been reported. Method of Analysis Ultimate follow-up information is missing in only 10 patients. In approximately 10 per cent of all the cases, the follow-up results have been obtained from local physicians, public health nurses, or social workers. Most of the patients who do not come back for follow-up feel well and see no need for a long journey just to be examined. A majority of the patients were followed in the Gynecological Clinic of the M. D. Anderson Hospital. Few autopsy reports were obtained, however, since most deaths occurred outside the hospital.