Local control prediction by histologic grading of radiation effects with drill biopsy specimens for uterine cervical cancer

Abstract

Purpose : Local control predictability by histologic grading for radiation effects was analyzed on 224 patients with cervical squamous cell carcinomas obtaining complete regression. Methods and Materials : The cervical specimens after radiation therapy were obtained by drill biopsy technic. Radiation effect was assessed with Shimosato's histologic classification for radiation effect. Results : The cancer tissues were altered by radiation to various degree from destruction of cancer nests with numerous viable cancer cells indicating grade 2a to scar tissues without viable or non-viable cancer cells indicating grade 4 at the end of treatment. Forty five percent of the patients had viable cancer cells remaining on the specimens at that time. The numbers of the grades 2a, 26, 3, and 4 in biopsy specimens were 36, 65, 39, and 84, respectively. The local control rates and 5-year survival rates were 53% and 28% for grades 2a, 75% and 51% for grade 2b, 95% and 74% for grade 3, and 92% and 76% for grade 4, respectively. The histologic grading was significantly associated with the local control and 5-year survival. Of 41 patients having remaining viable cancer cells, residual tumors disappeared in 33 patients (80%) and 8 (20%) still persisted to show grades 2a-b at 1 to 2 months after radiotherapy. Of the 8, all four patients without any salvage treatment, died of local recurrence. Conclusion : These results suggested that the remaining viable cancer cells in the specimens at 1 to 2 months after radiation therapy were highly associated with recurrence and that the histologic grading system was an indicator predictive for prognosis.