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J Korean Soc Ther Radiol Oncol > Volume 17(1); 1999 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 1999;17(1): 23-29.
Result of Radiation Therapy and Extrafascial Hysterectomy in Bulky Stage lB, llA-B Carcinoma of the Uterine Cervix
Jin Hee Kim, Ho Jun Lee, Tae Jin Choi, Soon Do Cha, Tae Sung Lee, Bae Kim
1Department of Therapeutic Radiology, Keimyung University, School of Medicine , Taegu, Korea.
2Department of Medical Biophysics Engineering, Keimyung University, School of Medicine , Taegu, Korea.
3Department of Gunecology, Keimyung University, School of Medicine , Taegu, Korea.
To evaluate the efficacy of tadiation therapy and eatrafascial hysterectomy in bulky stage lB,lla-B uterine cervix cancers.
Twenty four patients with bulky stage lB and llA-B carcinoma of the uterine cervix were treated with extrafascial hysterectomy following radiation therapy due to doubts of residual disease at Department of therapeutic radiology, Keimyung University, Dongsan Hospital , From April 1986 to December 1997. According to FIGO staging system, there were 7 Patients with stage lB, 9 patients with llA and 8 patients with llB stage whose median age was 45. Pathologic distribution showed 16 patients with squamous cell carcinoma and 8 with adenocarcinoma. Seven patients had tumors that are less than 5Cm in size 17 patients had tumors with larger than 5Cm.The mean interval between radiation therapy and extrafascial hysterectomy was 57 days. The radiation therapy consisted of irradition to the whole pelvis (180 cGy/fraction, Mean 4100 cGy)and parametrial boost ( for a mean total dose of 5000cGy) with midline shield (4x10Cm), followed by intracavitary irradiation up to 7500 cGy to point A (maximum 8500cGy). The maximum follow up duration was 107 months and mean follow up duration was 42 months.
Ten out 24 patients (41.7%)had residual disease found at the time of eatrafascial hysterectomies. Five year Overall survival rate (5Y OSR) and five year disease free survival rate (5Y DFSR) were 63.6% and 62.5% respectively . Five year overall survial rate for stage lB and llA was 71.4% and 50% for stage llB. There was a significant difference in 5Y OSR and 5Y DFSR between patients with and those without residual disease (negative vs Positive, 83.3% vs. 40% (p=0.01), 83.3% vs36% (p=0.01) respectively). There was a notable tendency of better survival with adenocarcinoma than with squamous cell carcinoma (adenocarcinoma vs squamous cell carcinoma, 85.7% vs. 53.3% (p=0.1), 85.7% vs. 50.9% (p=0.1) of 5Y OSR and 5T DFS respectivey). Total dose to A point did not make a significant difference in survival rate or the existence of residual lesion (<7500 cGy, > or =7500 cGy). It was also noted that significantly more frequent local have occurred in patients with positive residual residual disease compared with negative residual disease (5/10 vs. 0/14, p=0.003). There was no death related to treatment.
T here was no improvement of residual and to the overall survial rate in sqite of increased total dose to point A. We conclude that there is a possible beneficial of radiation therapy follow by extrafascial hysterectomy in survival for adenocarcinoma of bulky stage lB and llA-B uterine cervix. We need to this with follow up and large number of patients.
Key Words: Extrafacial hysterectomy, Carcinoma of the uterine cervix, Radiation therapy
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