Radiation treatment of carcinoma of the cervix with extension into the endometrium. A reappraisal of its significance

Abstract

During the period from 1969--1974, 561 patients with proven invasive squamous cell carcinoma of the cervix were treated by irradiation only in the Department of Radiation Therapy, University of Maryland Hospital. Of these, 82 patients were identified as having D & C positive for squamous cell cancer present in the curettings with or without endometrial tissue. Clinical staging was done using FIGO guidelines and the treatment of endometrial extension was the same as with regular cervical cancer. Of 82 cases who are eligible for a minimum five-year follow-up, the absolute five-year survival is as follows: Stage I, 68%, (17/25); Stage II, 62% (18/29); Stage III, 40% (10/25); Stage IV, 0% (0/3). The most interesting features are the local and distant failures in Stage I and II disease. Local failure in Stage I and II in this study is in line with other series. Distant metastasis, however, occurs at the rate of 20% in Stage I between 1--2 years after treatment (as compared to the control of 5%). In Stage II, the distant disease increases to 24% with a substantial number of local failure with distant metastasis. Based on our findings and others, it seems appropriate to suggest D &nd C be done routinely in order to identify the extension of cancer into the endometrium and treat them properly. Also it appears appropriate to re-examine our policy of the treatment to minimize both local and distant failures with suggestions outlined in Schema I and II along with possibility of a future chemotherapeutic management to minimize the distant disease.

FDG‐PET in carcinoma of the uterine cervix with endometrial extension

“…In previous studies, patients with endometrial extension have been shown to have a poor prognosis because of a higher rate of development of distant metastases, [2][3][4][5]18 but there was no explanation of this finding. Narayan et al has shown a correlation between magnetic resonance imaging (MRI) endometrial extension and FDG-PET-detected lymph nodes.…”

“…Therefore, we suggest that endometrial extension is correlated with lymph node metastases, which correlates with development of distant metastases and a worse prognosis. [2][3][4][5]18 In the absence of FDG-PET evaluation, evidence of endometrial extension may assist in assessing a patient-s risk of lymph node metastasis. This prognostic information may be useful in stratifying patients for risk-adjusted therapies.…”

What is the impact of corpus uterine invasion on oncologic outcomes in surgically treated cervical cancer?

“…High rates of pelvic lymph node metastasis, increased risk of distant metastasis, high rates of recurrence, and poor survival in patients with uterine invasion of cervical cancer were highlighted in these previous studies. 3,[13][14][15] However, their small sample sizes and/or lack of evaluation procedures for proving uterine invasion in cervical cancer due to the probability of contamination in D&C were the alleged obstacles of these studies. [13][14][15][16] Despite that, studies redrew attention to the prognostic importance of uterine corpus invasion in cervical cancer.…”

Nonsurgical Management of Cervical Cancer: Locally Advanced, Recurrent, and Metastatic Disease, Survivorship, and Beyond

“…1). 15–20 The relapse rate in those with PET-positive node disease has been reported to be approximately 50% after standard chemoradiation. 17,21,22 Some suggest that a follow-up fludeoxyglucose (FDG)-PET scan done 3 to 4 months postchemoradiation can predict patient outcome and may help to determine the intensity of follow-up needed.…”