The effect of overall treatment time on the survival and toxicity of radical radiotherapy for cervical carcinoma

Background and purpose: Overall treatment time is an important factor in the outcome of radical radiotherapy in head and neck, bladder and lung cancer and in cervix cancer treated over more than 7 weeks. This study analysed the effect of prolongation of overall treatment time on survival and late morbidity for patients receiving radical radiotherapy for cervical cancer treated with a 4-week regimen. Materials and methods: Using the departmental SAS data-base we identified all patients with cervix cancer treated between 1974 and 1988 and investigated the 647 patients who received 20 fractions of external beam radiotherapy plus intracavitary therapy with a total dose to point A of at least 60 Gy. A retrospective case-note review identified tumour and treatment-related variables. Results: Four hundred and twenty-five (66%) patients had at least one gap in treatment. Seventy-nine gaps (11%) were due to unavoidable patient or treatment-related causes. We could not find an effect of a treatment gap (P = 0.43) or an increased overall treatment time (P = 0.79) on the cause specific survival of patients. There was significantly more grade 4 morbidity in those patients treated over a short period (29-32 days) compared to the rest (P = 0.005), possibly related to the loss of radiotherapy-free days to weekend intracavitary insertions. Conclusions: We could not demonstrate a significant effect of overall treatment time in this series of patients, almost all of whom were treated in less than 7 weeks. Those patients treated over the shortest period had an increased incidence of late morbidity. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.