Radiotherapy for cervical cancer - Multi-institute retrospective analysis

Radiotherapy has long been recognized as a successful treatment modality for all stages of carcinoma of the uterine cervix. Patients present first at gynecologic clinics, and it is gynecologists in most institutions who determine the treatment modality without additional inputs of radiotherapists. Most gynecologists consider that surgical treatment is superior to radiotherapy, and, as a result, the majority of patients with stage 0-IIb become subjected to modified or radical hysterectomy and lymphadenectomy. Radiotherapists have to mostly treat the patients with far advanced cancer. Periodic check-ups for uterine cancer have become a very common practice for women over the age 30 years. As a result, the incidence of patients with early stages of cervical cancer subjected to surgery has increased, and that with advanced diseases significantly decreased in recent 10 years. Patients who have cervical cancer and visit radiotherapy department decreased to about 1/3, compared to 15 years ago. In 1983, the standard treatment method of cervical cancer with Co-60 RALS was proposed by Arai et al in Japan. Most institutes accepted this method with some modifications. JASTRO organized the study group to reconsider the treatment modality proposed by Arai et al and reviewed the outcomes from 9 major institutes in Japan. The treatment results of stages I and IVA were different in each institute in spite of applying the similar treatment modality. There was large difference of tumor sizes in stage IIIB. Arai et al suggested that stage IIIB must be subclassified into 3 groups according to tumor volumes, those were small, medium and large. The study group certified this subclassification was very useful to compare the treatment results of stage IIIB. Furthermore, the study group suggests that the more objective tumor measurement is necessary to compare the treatment results in a multiinstitutional study. As for stage IV, some institutes introduced CT and/or MR imaging to evaluate invasion to the rectum or the bladder, and reported good results. The study group found that the clinical staging system was so confused in Japan and suggested that the definition of the clinical staging system must be reconfirmed.