Metastasis to organs in carcinoma of the uterine cervix. Influence of treatment on incidence and distribution.

Abstract

Two hundred seventy-eight autopsied cases of various stages of cervical cancer treated at Roswell Park Memorial Institute, Buffalo, New York, were evaluated to determine the effect of treatment on the spread of the disease. Patients were categorized, according to the primary treatment, into four groups: radiation, 183 cases; surgery, 44 cases; combined radiation and surgery, 34 cases; and other methods, 17 cases. The main clinical parameters of prognostic value were equally present except for earlier clinical stages in the “surgery” and “combined” groups. Clinically, the patterns of recurrence varied with the treatment: increased central pelvic recurrences after surgery, lateral deep pelvic recurrences after combined treatment and distant metastases after radiation. The mean survival in all cases was higher than previously reported, and still higher after radiation. Renal failure and sepsis were the leading causes of death. In the autopsy findings patients having radiation showed an increased risk of extrapelvic metastases whereas the surgical group revealed an increased risk of general pelvic and extrapelvic metastases. This may be explained by the longer survival in both groups, with more frequent local control after radiation. Distant metastases were widespread and the distribution was unaffected by the kind of treatment given for the primary disease.