L E ?J 40

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n iii 1 20

.-Neg DsC ,_

.- kg D&C a L O-Pm D&C

20

L o-Ppos D&C 1 0 2 3 4 5

II__i___L_ 0 I Time, years

2 3 4 5

Time, years

3(a) 3(b)

Fig. l!A and B). Absolute survival rates in Stages I and II showing decreased survival (about lO-15% less at 5 years) in the patients with cervical carcinoma in the endometrial curettings (positive D & C).

(130) MANAGEMENT OF THE LATE SECOND OR LATE RECURRENT SQUAMOUS CELL CARCINOMA OF THE CERVIX AFTER SUCCESSFUL INITIAL TREATMENT

Ralph M, Scott, M.D.*, Thongbliew Prempree, M.D,, PhODO*, Tae Kwon, M.D.** and Umberto VillaSanta, M.D., F.A,C.O,G.**

* Department of Radiation Therapy ** Department of Obstetrics and Gynecology

University of Maryland Hospital, School of Medicine, Baltimore, Maryland 21201

Late second or recurrent squamous cell carcinoma of the cervix uteri following successful initial treatment is rare and accounts for less than 1% of all cervical cancer cases treated in this institution, Over the past 20 years we have observed a total of 17 such patients, all of whom have had a greater than 10 year interval between the first and second cancer. These cases present interesting and difficult management problems.

Recurrence After Surgery: Three of the 17 cases had late recurrence following total abdominal

hysterectomy and bilateral salpingo-oophorectomy for Stage 0 disease, Two of these, one Stage II and one Stage III, were treated by appropriate radiation. One other Stage I case was treated by partial vaginectomy, All have survived without evidence of disease for more than 5 years,

Recurrence After Irradiation: A) After disease-free intervals ranging from 10 to 32 years, eight of

17 patients had late or new second cancers following conventional irradiation (x RT + Ra). Six unsuitable for surgery were re-irradiated (external radiation plus intracavitary and interstitial radium) with a 50% success rate (3/16 NED - 5 years). Two cases, one following failure of a second attempt at irradiation, successfully underwent total pelvic exenteration, Survival of this group was 5 of 8 NED for 5 years.

B) Five of 17 patients had insitu carcinoma (CIS) and four of these were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy=.

154 ASTR 21st Annual Meeting

The fifth had total pelvic exenteration when minimal invasion was found. Five of the six (5/6 = 83%) survived five years without evidence of disease, The overall responses for all cases was 13 of 17 (13/17 = 76,5%)

This presentation intends to demonstrate that late or second recurrent cervical cancer requires individualized, aggressive treatment. Re-irradiation utilizing external, intracavitary and interstitial techniques is often successful. Examples including dosimetry will be discussed, The need for continued, careful follow-up over many years, particularly in the younger age group, is emphasized.

(131) A NEW TREATMENT TECHNIQUE FOR PELVIC & PARA-AORTIC NODAL AREAS UTILIZING A COMPUTER-CONTROLLED THERAPY MACHINE

L.M. Chin, P.K. Kijewski, G.K. Svensson, B.E. Bjarngard, and J.T. Chaffey

Joint Center for Radiation Therapy, Department of Radiation Therapy, Harvard Medical School, Boston, MA 02115

A method of computer-controlled radiation therapy is described which is suitable for treating a pelvic primary tumor and its nodal drainage pattern in the pelvis and para-aortic nodes.

Previous attempts to treat the pelvic and para-aortic nodes to high doses have resulted in an unacceptable complication rate due to the large amount of normal tissue, primarily small bowel, irradiated to a high dose.

The CT body scanner has allowed more accurate definition of the pelvic and para-aortic nodal target volume than was previously possible. Utilizing this information an individualized treatment can be generated which delivers less dose to the normal tissues surrounding the target volume for the same dose to the nodal target tissues.

The planned treatment is delivered by 5 scanned fields, accomplished by longitudinally translating the patient through a radiation field. During the scan, the dose rate, gantry angle, and field width are varied in non-linear predetermined patterns under computer control.

The measured dose distributions agree with calculations within 5%, and comparisons of a typical treatment plan and measured dose distributions in a phantom will be shown..

A comparison will also be made between this new plan and an optimized conventional ap'proach for treating the pelvic and para-aortic nodes. The advantages of decreased dose to sensitive normal tissues for the same tumor dose, flexibility in individualizing the treatment plan, and absence of match lines will be discussed.

Supported by USPHS Research Grant Ca 17588 from the National Cancer Institute

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