Reporting radiotherapeutic complications in patients with uterine cervical cancer. The importance of latency and classification system.

Radiotherapeutic morbidity is reported according to our own system (AADK) and the Franco-Italian glossary (FI) in 442 patients with cervical cancer FIGO stage IIB (139), IIIA (10), IIIB (221), and IVA (72). The AADK system records each symptom, date of appearance, the required therapy, and its initial date. FI describes the maximal damage in 4 grades. Actuarial estimates of moderate or worse complications in the rectosigmoideum differed significantly in relation to stage, while frequencies did not differ. Frequencies were up to 25% lower than the actuarial estimates. Moderate AADK complications in the rectosigmoideum occurred from 1 to more than 24 months in 42% of stage IIIB patients finally developing severe FI complications, and during more than 2 years in 24% of the patients dying from rectosigmoid complications. An analysis of the probability of being alive without moderate or worse AADK complications indicated that survival and complications were unrelated. It is concluded that, with any classification system for reporting morbidity, each symptom and required therapy used in the definition of each complication grade and the date of appearance should be registered regularly to allow (1) reporting of the real risk of organ damage, (2) rescoring of complication grades, (3) separation of early and late morbidity, and (4) reporting of actuarial estimates. If these minimum requirements are met, underestimation of morbidity is avoided.