The role of radiotherapy for patients presenting with disseminated cervical cancer at initial diagnosis

Abstract

Purpose: The objective of this study was to clarify the role of radiotherapy (RT) for patients presenting with disseminated cervical cancer at initial diagnosis.Patients and Methods: We retrospectively analyzed 77 patients diagnosed with disseminated cervical cancer between September 1980 and August 2012. All patients received external beam RT to the pelvis (median dose 45 Gy) and 60 patients (77.9%) treated with high dose rate brachytherapy (median dose 30 Gy). Sixty-four patients (83.1%) received chemotherapy and 12 patients (15.6%) underwent radical surgery including hysterectomy. We divided into two groups; 58 patients had distant lymph node metastasis only or peritoneal seeding without visceral organ metastasis (group A), 19 patients had visceral organ metastasis (group B).Results: Median follow-up time was 55 months (range, 15 to 296 months). The 5-year pelvic control rates (PCR), progression free survival (PFS), and overall survival (OS) were 83.7%, 25.1%, and 31.7%, respectively. On univariate analysis, OS rate of the group A were significantly better than that of group B (38.9% vs. 10.5%, P = .001). Multivariate analysis indicated that group B was the only significant independent prognostic factor for PFS and OS. Five-year PCR of group A and B were 82.6% and 89.5%, respectively.Conclusion: Our data suggests definitive RT be beneficial to disseminated cervical cancer patients without visceral organ metastasis. External beam pelvic RT alone might be considered to palliate symptom and delay pelvic progression in patients with visceral organ metastasis who are expected to have poor prognosis and need systemic chemotherapy.