Definitive radiation therapy in the treatment of carcinoma of the uterine cervix. Treatment results and prognostic factors.

219 patients suffering from cervix carcinoma received definitive radiation therapy using moderate doses of external beam therapy and high dose-rate afterloading brachytherapy from 1979 to 1986. At five years, the actuarial survival (AS) for stage Ib patients was 81%, for stage IIa 53%, for stage IIb 56%, for stage IIIa 25%, for stage IIIb 33% and for stages IVa and IVb 0%. Significant prognostic factors for actuarial survival were FIGO stage, histological type, grading and, marginally, age of the patient at the time of diagnosis. The survival data censored for death caused by intercurrent disease (tumor related survival, TUS) at five years were: 90% (Ib), 66% (IIa), 63% (IIb), 50% (IIIa), 41% (IIIb) and 0% (IVa and IVb). The prognostic factors were stage and grading. Age and histology failed to be a significant prognostic factor. The disease-free survival (DFS) according to FIGO stage at five years were: Ib 84%, IIa 64%, IIb 59%, IIIa 50%, IIIb 38%, IVa and IVb 0%. Prognostic factors for disease-free survival were limited to FIGO stage and grading. The five-year local control results (LC) according to stage were 90% (Ib), 64% (IIa), 67% (IIb), 43% (IIIb) and 0% (IVa and IVb) with stage as prognostic factor. High dose-rate afterloading therapy for cervix carcinoma yields good results for local control and survival with a low ratio of severe side effects (6%). Radiation therapy eliminates the prognostic influence of histological type and grading of the tumor on local control. External beam and afterloading doses, however, are relevant factors for prognosis, if the patients are stratified by FIGO stage.