1181 10 year results of external beam and HDR intracavitary irradiation in the primary treatment of cancer of the uterine cervix

From August 1980 to December 1990, 303 patients with cancer of the uterine cervix underwent primary irradiation in a combination of external beam and HDR intracavitary treatment at the Department of Radiation Oncology at the Sisters of Mercy Hospital in Linz, Austria. All patients were classified according to the FIGO rules: Stage I 54 patients, stage II 171, stage III 75 and stage IV 3 patients. 8 patients were lost to follow up. The mean follow up time of survivors is 110 months. A complete remission could be achieved in 282 patients, which is 93%; persistent turnout was found in 21 patients at the first follow up check 3 to 5 months after completion of irradiation. The actuarial overall survival probability for all patients at 5 and 10 years is 62% and 42% respectively, the disease specific survival probability is 68% and 64%. The local control rate at 5 and 10 years is 73% and 72% respectively. According to stage, disease specific survival lies at 90% for stage I, 69% for stage II, and 48% for stage III and IV at 5 years, and at 10 years 87%, 66% and 41% respectively. The actuarial local control probability for stages I, II, and III/IV is 90%, 74%, 60% respectively at 5 years, and 88%, 74%, and 56% at 10 years. (Kaplan-Meier calculations). From all 303 patients 34 suffered from 40 severe and moderate side effects (glossary of Chassagne and Sismondi). The rate for grade II complications is 10% and for grade III 3%. We conclude that HDR after loading in addition to external beam radiotherapy is a very effective tool for primary irradiation of cervical cancer, and a safe one in experienced hands.