From April 1969 through December 1980,203 patients with Stage 111 epidermoid carcinoma of the cervix were treated with radiation therapy with curative intent. The disease-free survival at 2, 5, and 10 years was 50%, 33%, and 27%, respectively. The survival was better for patients with Stage IIIB disease than for those with Stage IIIA disease. Eighty-eight patients were treated with external beam therapy only, and 1 I5 received external beam and brachytherapy. The disease-free survival was better for the combination therapy group initially, but this difference was not sustained beyond 5 years. One hundred eight patients experienced recurrence within the irradiated field, for a locoregional recurrence rate of 53%. Twentyseven patients had complications (13%). The complications were mild in 13 patients, moderate in 4 patients, and severe in 10 patients. A study was made of the relationship of the dose to Point A and the occurrence of complications. Similar analyses were made of the bladder and rectal doses and the subsequent occurrence of urinary and intestinal complications. In these analyses, the mean dose to Point A and the critical organs was higher for the groups of patients with complications than for those patients without complications. This relationship was also observed when the patients were stratified for treatment with either external beam plus brachytherapy or external beam therapy alone.
Cancer 57:148-154, 1986.
ERVICAL CARCINOMA can be detected at a very early C stage with the Papanicolau smear or by visual inspection of the cervix during a routine gynecologic examination; however, many patients still present with relatively advanced disease. In most large series the distribution of cases is weighed toward the more advanced stages, Stages IIB, IIIA, and IIIB, with the proportion of patients with Stage IV disease being relatively small. Radiation therapy is the primary treatment for patients with Stage 111 disease. In general, the approach with radiation therapy entails the use of external beam treatment followed by brachytherapy. In instances in which there is tumor involvement of the distal vaginal canal, interstitial therapy or vaginal cylinders may be used with or without the standard intracavitary therapy. When anatomic rea-From the