16 Cervix Carcinoma

350 Cervix Cancer

Classification In invasive carcinoma of the cervix, a distinction is made taking into account the treatment regimen between limited disease and extended disease. Limited disease includes FIGO stages IB, IIA and IIB, when involvement of the vagina is limited to the upper third (proximal IIA) and/or when involvement of the parametria is limited to their internal third (proximal IIB). These limits determine the limits in terms of surgical indications. With regard to large volume stage IB (IB 2 : > 4.0 cm), some authors now consider IB 2 locally advanced disease. Locally advanced disease consists of stages IIIA-IIIB, IVA and also IIA-IIB when tumour involvement of the vagina extends beyond the upper third (distal IIA) and/or when tumour involvement of the parametria extends beyond the internal third (distal IIB). A major problem is that most studies do not refer to this classification. Stage II is then defined regardless of tumour extension. 11.1.1 Limited disease 11.1.1.1 Surgery (+/- postoperative radiotherapy) Table 1: Results of surgery (+/- postoperative radiotherapy) Authors N° pts Stage 5-yr survival (%) Postop RT Averette (1) 726 IB, IIA 88 No Bianchi (7) N+ only

97 15

IB IIA

96 (83 in N+) 93 (76 in N+)

Brunswig (10)

200 284 122 8 195 103 42 55 162 73 57 120

I II

79 54 82 50 77 84 69 67 84 68 54 87

No

Burghardt (11)

IB IIA IIB

T size N+

Dargent (20)

IB IIA IIB prox.

±

Kristensen (68)

IB IIA IIB IB

Masterson (75) No The 5-yr survival rate according to stage varies from 79 to 84% for stage I and from 54 to 77% for stage II. These results are comparable to the results of the last annual report: 90% and 67% for stage I and II respectively (34). 11.1.1.2 Combined radiotherapy and surgery The retrospective largest series presented here systematically included brachytherapy (LDR) followed by surgery and completed by external beam radiotherapy, performed before brachytherapy in IB 2 cases or after surgery in case of positive nodes.