2165 Accelerated radiotherapy for locally advanced cervix cancer achieves the same improvements in local control and survival as chemoradiotherapy

Proceedings

of the 41st Annual

ASTRO

363

Meeting

that was not irradiated had more intense FDG uptake on follow-up FDG-PET. One patient with persistent lymph of disease. Two patients had new sites of FDG uptake on follow-up imaging and one is dead of disease. Conclusion:

FDG-PET

is a useful

diagnostic

tool to evaluate

the response

to irradiation

TABLE: PET = positron emission tomography; + = positive for tumor; - = negative for tumor; SVC = supraclavicular node; ** = not treated with irradiation . - _. - . . _ _. I PrimSly Prima I-= Patient No. 1 2 3 I

I 1 ) I I

4

2 165 Segreti MCV

Stage

---

Ih? IIIb IIIb Ib2

I 1 I I I

Histology

Tumor

I --_.--I

I 1 I I I

R”,l.rn”,,. Squamous squamous squamous

PET Tumor + I + + ? I + I -

ACCELERATED RADIOTHERAPY THE SAME IMPROVEMENTS CHEMORADIOTHERAPY

EM; Kavanagh Hospitals,

Virginia

BD,

Koo D, West

Commonwealth

RJ, Amir

for tumor; _

of the uterine

cervix.

? = questionable _ _

^

_ .

SVC+

-

+ + + .

FOR IN LOCAL

University,

of carcinoma

node uptake is dead

LOCALLY CONTROL

C, Arthur

DW:

Richmond,

+**

+**

+

-

ADVANCED CERVIX CANCER AND SURVIVAL AS Burks

RT. Fulcher

AS, Schmidt-Ullrich

ACHIEVES

RK

VA, USA

Purpose: Recent reports have documented the value of combining chemotherapy with radiotherapy in the management of locally advanced uterine cervical carcinoma, with expected reductions in loco-regional failure of 33.45% and reductions in risk of death of 39.52% (Rose et al&on-is et al, N Engl J Med, 1999). The present work updates results form a phase II trial of concomitant boost accelerated superfractionated radiotherapy (CBASF RT) for locally advanced cervix cancer to assess whether intensification of local treatment alone can provide similar improvements in outcome as the addition of systemic treatment. Methods and Materials: The analysis includes fifty consecutive patients with FIG0 stages IIIA-IVA managed with RT alone with curative intent. Twenty patients treated on a previously reported trial of CBASF RT (Kavanagh et al, IJROBP. 1997) were compared with 30 patients treated contemporaneously with conventionally fractionated RT (CF RT). Both groups received pelvic external beam RT prior to 1 or 2 low dose rate brachytherapy procedures intended to provide a total dose of 85-90 Gy to point A. Kaplan-Meier methods were used to determine actuarial rates of loco-regional failure and overall survival. Results: Followup time is greater than 4 years in 82% of patients. Median total length of treatment (external beam + brachytherapy) was 46 days for the CBASF group and 70 days for the CF group. The 4-year actuarial estimates (+/- s.e.m.) of local control were 79 +/- 9% for CBASF RT and 67 +/- 9% for CF RT, corresponding to a 36% reduction of loco-regional failure. Survival estimates at 4 years were 64 +/- 11% for CBASF RT and 42 +/- 10% for CF RT, corresponding to a 38% reduction in risk of death. Cox multivariate analysis including pre-treatment hemoglobin, tumor burden score, point A dose. and maximum tumor size failed to identify any other significant prognostic variable. Conclusions: In the present series, with median followup longer than recently reported trials of combined chemoradiotherapy for locally advanced cervix cancer, local control and survival were improved with CBBASF RT by a magnitude similar to the degree of improvement afforded by the use of concurrent chemotherapy when compared with standard once-daily RT alone, Efforts to continue to improve local control rates with combinations of chemotherapy and alterations of radiotherapy techniques are warranted since improvements in local control are reflected in improvements in survival.

2 166 Zaghloul National

PROGNOSTIC CANCER

IMPLICATION

OF APOPTOSIS

MS, El Naggar M; El Deeb A, Khaled H, Mokhtar Cancer Institute-Cairo Univ., Cairo, Egypt

AND

ANGIOGENESIS

IN CERVICAL

UTERI

N

The pathological materials of 40 cervical uteri squamous cell carcinoma patients were examined and immunohistochemically stained to determine the tumour angiogenesis (tumour microvascular density) using factor VIII related antigen and their tumour apoptotic index (AI) using TUNEL method. The patients were 3 stage I, 18 stage II, 15 stage III and 4 stage VI FIG0 classification. All patients were treated with radical radiotherapy and all were followed up for more than 2 years. The mean AI