The adverse effect of treatment prolongation in cervical carcinoma

Daniel G. Petereit, Jann N. Sarkaria, Richard Chappell, John F. Fowler, Trudy J. Hartmann, Timothy J. Kinsella, Judith A. Stitt, Bruce R. Thomadsen, Dolores A. Buchler

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200 Scopus citations

Abstract

Purpose: Proliferation of surviving tumor clonogens during a course of protracted radiation therapy may be a cause of local failure in cervical carcinoma. The effect of total treatment time was analyzed retrospectively in relation to pelvic control and overall survival for squamous cell carcinomas of the uterine cervix. Methods and Materials: Two hundred and nine patients (Stage IB-IIIB) treated with a combination of external beam and low dose rate intracavitary irradiation were evaluable for study. Multivariate analysis and Kaplan-Meier statistical methods were used to determine the effect of treatment time on pelvic control and survival at 5 years. Results: The median treatment duration was 55 days. For all stages combined, the 5-year survival and pelvic control rates were significantly different with treatment times < days vs. ≥ 55 days 65 and 54% (p = 0.03), 87 and 72% (p = 0.006), respectively. By stage, a shorter treatment duration (i.e., < 55 days vs. ≥ 55 days) was significant for 5-year overall survival and pelvic control for Stages IB/IIA and III, but not for Stage IIB: Stage IB/IIA (81 and 67%, and 84%), Stage III disease (52 and 42%, 76 and 55%) and Stage IIB (43 and 50%, 74 and 80%, respectively). Survival decreased 0.6%/day and pelvic control decreased 0.7%/day for each additional day of treatment beyond 55 days for all stages of disease. Additionally, significantly late complications were not influenced by treatment time. Conclusion: These results that prolongation of treatment time is associated with decreased local control and survival in patients with cervical carcinoma. This is consistent with emerging data from other institutions. Therapeutic implications include avoidance of unnecessary treatment breaks, the design of fractionation schemes that decrease treatment duration, and possibly the use of tumor cytostatic drugs during conventional radiation.

Original languageEnglish (US)
Pages (from-to)1301-1307
Number of pages7
JournalInternational journal of radiation oncology, biology, physics
Volume32
Issue number5
DOIs
StatePublished - Jul 30 1995

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Keywords

  • Carvical cancer
  • Complications
  • Overall time
  • Predictors of recurrence
  • Proliferation
  • Radiation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Petereit, D. G., Sarkaria, J. N., Chappell, R., Fowler, J. F., Hartmann, T. J., Kinsella, T. J., Stitt, J. A., Thomadsen, B. R., & Buchler, D. A. (1995). The adverse effect of treatment prolongation in cervical carcinoma. International journal of radiation oncology, biology, physics, 32(5), 1301-1307. https://doi.org/10.1016/0360-3016(94)00635-X