Long-term results of treatment of cervical carcinoma in the United States in 1973, 1978, and 1983: Patterns of Care Study (PCS).

PURPOSE To extend the observations of patients with carcinoma of the cervix treated in 1973 for over 15 years, in 1978 for over 10 years, and in 1983 for over 5 years for survival and local control to compare treatment times and outcome. METHODS AND MATERIALS A nationwide survey of the patterns of practice in radiation therapy for patients with squamous carcinoma of the cervix collected pretreatment and treatment data using external surveyors who reviewed patients' records. Outcome information was updated for the three separate databases by mail survey. Overall survival, no evidence of disease (NED) survival, and local control curves by stage were plotted using the estimates derived by the Kaplan-Meier method. RESULTS Total number of patients surveyed was 1686: 937 patients in 1973, 565 patients in 1978, and 184 patients in 1983. These are the results from changes in treatment policy, particularly the increasing use of brachytherapy. Of Stage III patients, the percentage receiving brachytherapy was 60.5% in 1973, 76.5% in 1978, and 87.9% in 1983 (p < 0.001 by linear trend test). Also, there was an increased proportion in use of higher energy for external pelvic irradiation during the more recent time period, e.g., 28% in the 1973 study, 60% in the 1978 study, and 87% in the 1983 study compared to the usage of cobalt-60 equipment. Comparison of results including overall survival, local control, and NED survival for the three different time periods showed improvement in outcome for Stage III in 1983, but not Stages I and II. The 5-year survival for Stage III increased from 25% in the 1973 survey to 47% in the 1983 survey, a linear trend that is statistically significant (p = 0.02). CONCLUSION The long-term results of radiotherapy for patients with carcinoma of the cervix show improved outcome for Stage III patients, which probably results from improved treatment, including higher energy for pelvic irradiation and increase in use of brachytherapy contributing better local control and fewer complications.

[1]  P. Grigsby,et al.  Distant metastases after irradiation alone in carcinoma of the uterine cervix. , 1992, International journal of radiation oncology, biology, physics.

[2]  H. Olsson,et al.  Cutaneous malignant melanoma in South Sweden 1965, 1975, and 1985. A histopathologic review , 1994, Cancer.

[3]  A. Agresti.  Categorical data analysis , 1993 .

[4]  V. Marcial,et al.  Radiation therapy of cervical cancer. New developments. , 1993, Cancer.

[5]  Sellers Ah.  Supervoltage Radiation Treatment in Advanced Cancer of the Uterine Cervix , 1969 .

[6]  P. Schwartz,et al.  Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariable analysis of the effect of age, stage, histology and blood counts on survival. , 1983, International journal of radiation oncology, biology, physics.

[7]  A J Dembo,et al.  Definitive evidence for hypoxic cells influencing cure in cancer therapy. , 1978, The British journal of cancer. Supplement.

[8]  Jayant V. Deshpande,et al.  A Nonparametric Introduction to Statistics. , 1970 .

[9]  G. Montana,et al.  Influence of age, prior abdominal surgery, fraction size, and dose on complications after radiation therapy for squamous cell cancer of the uterine cervix. A patterns of care study , 1992, Cancer.

[10]  T. Pajak,et al.  The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. , 1993, International journal of radiation oncology, biology, physics.

[11]  L. Coia,et al.  Comparison of 1 vs 2 or more intracavitary brachytherapy applications in the management of carcinoma of the cervix, with irradiation alone. , 1991, International journal of radiation oncology, biology, physics.

[12]  R. Markert,et al.  Cervical Cancer: Women Aged 35 and Younger Compared to Women Aged 36 and Older , 1991, American Journal of Clinical Oncology.

[13]  T. Pajak,et al.  Technically accurate intracavitary insertions improve pelvic control and survival among patients with locally advanced carcinoma of the uterine cervix. , 1994, Gynecologic oncology.

[14]  R. Beran,et al.  A Nonparametric Introduction to Statistics. , 1970 .

[15]  G. Hanks,et al.  A reappraisal of the international federation of gynecology and obstetrics staging system for cervical cancer. A study of patterns of care , 1992, Cancer.

[16]  G. Fletcher,et al.  Analysis of the severe complications of irradiation of carcinoma of the cervix: whole pelvis irradiation and intracavitary radium. , 1983, International journal of radiation oncology, biology, physics.

[17]  G E Hanks,et al.  Tumor and treatment factors improving outcome in stage III-B cervix cancer. , 1991, International journal of radiation oncology, biology, physics.

[18]  G. Hanks,et al.  Patterns of care outcome studies results of the national practice in cancer of the cervix , 1983, Cancer.

[19]  G. Fletcher.  Textbook of radiotherapy , 1973 .

[20]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[21]  J. Cox,et al.  Moss' radiation oncology : rationale, technique, results , 1994 .

[22]  L. Coia,et al.  Pretreatment and treatment factors associated with improved outcome in squamous cell carcinoma of the uterine cervix: a final report of the 1973 and 1978 patterns of care studies. , 1991, International journal of radiation oncology, biology, physics.

[23]  Joseph Sedransk,et al.  Distinguishing among Distributions Using Data from Complex Sample Designs , 1979 .

[24]  S. Leibel,et al.  Is local failure a cause of or a marker for metastatic dissemination in carcinoma of the uterine cervix? , 1992, International journal of radiation oncology, biology, physics.

[25]  C. Guse,et al.  Prophylactic irradiation of the para-aortic lymph node chain in stage IIB and bulky stage IB carcinoma of the cervix, initial treatment results of RTOG 7920. , 1990, International journal of radiation oncology, biology, physics.

[26]  J. Purdy,et al.  Radiation therapy alone in the treatment of carcinoma of uterine cervix I. Analysis of tumor recurrence , 1983, Cancer.

[27]  N. Mantel.  Evaluation of survival data and two new rank order statistics arising in its consideration. , 1966, Cancer chemotherapy reports.

[28]  D. Cox.  Regression Models and Life-Tables , 1972 .

[29]  B. Bundy,et al.  Carcinoma of the cervix treated with chemotherapy and radiation therapy: Cooperative studies in the gynecologic oncology group , 1993, Cancer.

[30]  W. E. Allt.  Supervoltage radiation treatment in advanced cancer of the uterine cervix. A preliminary report. , 1969, Canadian Medical Association journal.

[31]  M. Pike,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. , 1977, British Journal of Cancer.