The Results of Curative Radiotherapy for the Uterine Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate 5-year survival rate, patterns of failure and complications of cervical cancer treatment, fifty nine patients treated by curative cancer were analyzed retrospectively. METHODS AND MATERIALS : From March 1986 to May 1990, fifty nine patients with histologically proven uterine cervical cancer were analyzed. According to FIGO stage, there were 2 patients (3.4%) in stage Ib, 2 patients (3.4%) in stage IIa, 31 patients (52.5%) in stage IIb, 15 patients (25.4%) in stage IIIb, 9 patients (15.3%) in stage IV, External RT was per formed by 6 MVLINAC with daily 1.8 Gy, 5 times per week and followed by ICR, A point dose of ICR was calculated to 30-43.66 Gy (median : 34.6Gy). These techniques delivered total A point dose of 80.4 to 109.8 Gy (median : 85Gy). Patients had been followed up from 2 to 110 months (median : 61 months) RESULTS: The overall 5-year survival rate & disease free survival rate were 55.9% and 55.0 % respectively. According to FIGO stage, the 5-year survival rate for less than Iia, IIb, IIIb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage IIb and below versus stage llla and above revealed 74.8%, 29.2% respectively (p<0.005). According to FIGO stage, the 5-year survival rate for less than lla, llb, lllb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage llb and below versus stage llla and aboce revealed 74.8%, 29.2% respectively (p<0.005). According to the hemoglobin level during RT, the 5-year survival rate of was 73.3% for patients with Hg 10 gm/dL or higher, in contrast to 0% for those with lower than 10 gm/dL (p<0.005). In 18 patients with nonbulky tumor (<5 cm), the 5-year survival rates were 71.8%. The 5-year survival rates for 18 patients with 5 cm or greater in tumor diameter were 22.2% (p<0.005). The 5-year survival rate for patient age of above 50 years and below were 65.3%, 34.2% respectively (p<0.05). ECOG performance status, pathologic finding, total dose, total treatment time were not statistically significant factors. The significant prognostic factors affecting overall 5-year survival rate by multicariate analysis showed the hemoglobin level during RT (p=0.0001), tumor size (p=0.0390), FIGO stage (p=0.0468) Total recurrence rate was 23.7%; local failure 15.2% (9/59), distant metastasis 6.8% (4/59), local and distant metastasis 1.7% (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59). The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively : 10 patients(17.0%) were grade 2, 3 patients (5.1%) were grade 3 and one patient (1.7%) (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59). The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively : 10 patients (17.0%) were grade 2,3 patients (5.1%) were grade 3 and one patient(1.7%) was grade 4. The late complications were radiation proctitis, rectal bleedint, radiation colitis, diarrhea and radiation cystitis in decreasing order. CONCLUSION: For improvement of therapeutic results, prospective randomized trials are recommended to discover new prognostic factors and more aggressive radiation therapeutic methods are needed for poor prognostic patients. The adjuvant chemotherapy or radiation-sensitizing agents must be considered to inhibit regional and distant metastasis.

Two Stage Operation for Large Cerebral Arteriovenous Malformation

This report describes three cases of large arteriovenous malformation which were removed totally with two stage operation. When a large arteriovenous malformtaion had to be removed, prediction of profuse bleeding and brain swelling could be made. We clipped large feeding arteries and arteires and made a cleft around the AVM during the first operation, and the progressive reduction of the shunt flow by clipping the dominant peduncles on after the other diminished the risk of profuse bleeding and brain swelling. 7 to 10 days later, we removed AVM totally as the second operation. All three lesions were resected by microsurgical techniques, and the results were excellent. The rationale for the two stage operation for large cerebral AVM is discussed.