16 Cervix Carcinoma

Cervix Cancer 351

Table 2: Results of preoperative radiotherapy and surgery

Authors

N° pts

Stage IB, II

5-yr survival (%)

Local control (%)

Bachaud (2) Calais (12)

115

82

87

70 45

IB IIA-B prox.

92 78 (10 yr OS)

100 93

Durand (24)

228 84 983 288 103 118 82 415

I II

81 OS

85

Fletcher (36) Gerbaulet (39)

IB, IIA

60 (?) 88 DFS 83 DFS 81 DFS 67

IB IIA-B prox.

92 89

Grigsby (47 )

IB II

Lasry (70)

T1 331 T2 84 IB, IIA

82 OS 10y 59

93 85 87 70

Muirhead (79) Pernot (92)

1576

79

205 101

IB II

78 DFS 60

For the French school (24,41,78), the advantage of combining brachytherapy and surgery is to select patients who need complementary EBRT and to decrease the morbidity induced by brachytherapy and by surgery, each treatment being completed by the other. Nevertheless, this combined treatment must be reserved for stages IB and proximal II, as distal stage II is considered as locally advanced disease and is treated by definitive radiotherapy (92). For these series, 5-year survival ranges from 81 to 92% for stage IB and from 78 to 85% for proximal stage II. If the tumour size exceeds 4 cm, patients are treated with a combination of external irradiation and concomitant chemotherapy, followed by brachytherapy. In these cases the role of complementary surgery is still questionable, as no available data have shown a benefit from surgery in this situation. 11.1.1.3 Definitive radiotherapy A larger number of results have been published for all stages of uterine-cervix cancer, including limited disease, some of which are reported here. The treatment consists of a combination of external beam radiotherapy and brachytherapy. The selection is mainly based on the treatment methods described in detail before: Manchester, Fletcher, Dijon, IGR, Vienna.