Parametrial implants in the treatment of stage IIIB carcinoma of the cervix. II. Analysis of success and failure.

Abstract

Local failure (in the cervix and pelvic wall) continues to be a major reason for poor results following conventional radiation treatment of Stage IIIB (FIGO) carcinoma of the cervix. Attempting to minimize this local failure, in 1975 and early 1976, the Radiation Therapy Department, University of Maryland Hospital, began using a parametrial implant technique in a selected group of patients who had met the criteria for implant in Stage IIIB carcinoma of the cervix. Essentially, prior to radium implant, all patients received whole-pelvis irradiation (4000-5000 rad TP/four to five weeks) plus an appropriate parametrial boost to the affected side (pelvic wall to 5500 rad/over five and a half weeks). Two types of radium were given: 1) a protruding tandem with parametrial implant by means of radium needles; and 2) a radium implant to the lower segment of uterus and affected parametrium plus a vaginal colpostat in cases of severe shortening (or absence) of the uterine cavity or when we were unable to identify the uterine cavity. A total of 31 cases were treated with one or the other of these techniques and have been followed for a minimum of three years. Results show an absolute disease-free survival rate of 64.5% (20 of 31) with a determinate disease-free survival rate of 71.4% (20 of 28). The overall local control rate is 84% (26 of 31). Analysis of local and paraaortic failures as well as distant metastases and complications are presented in detail.