After radiotherapy for cervical carcinoma

Cervical carcinoma can be treated with the association brachytherapy and surgery. With this technique, the incidence of rectal complication is low, about 1 %104-106. Perez107'108 has compared preoperative radiation followed by surgery with radiation alone in a randomized and in a retrospective trial: major rectal complications were more frequent with radiation alone, but not significantly: 5.7 % versus 0 %, and 3.4 to 6 % according to the tumour stage versus 1 to 4.5%.

Using radiation alone (external beam irradiation and brachytherapy) the incidence of severe rectal complications is variable. Perez109 in 1456 patients found respectively 4.1 %, 3%, and 3 % of major rectal, bladder and small intestinal complications. The most frequent grade 2 sequelae were proctitis (3%) and cystitis (0.7%) (Table 2.2.8-1).

Several studies have shown the superiority of concomitant chemo-radiotherapy versus radiotherapy alone, or concomitant chemo-radiotherapy more surgery versus radiotherapy more surgery for locally advanced or high-risk disease112-117. Whitney116 found the same incidence of late intestinal or urinary major complications at 3 years (about 16%) but chemotherapy was given in the 2 arms.

Morris113 who compared radiotherapy alone and radiotherapy more 5 Fluoro-uracil and cisplatin found no significant difference in "late" effects (occurring or persisting more than 60 days after the completion of the treatment): about 7.5% and 1% of severe rectosigmoideal and bladder complications. Tseng118 found no difference in late intestinal or urinary complications too. However these studies are recent, with a short follow-up; Grigsby119 reported higher complication rates in a series of patients treated with concomitant chemoradiotherapy (5 fluorouracil and cisplatin).

372 D. Pasquier, J. Schmutz and E. Lartigau Table 2.2.8-1. Major complications at 5 years, using radiation alone_
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