Parametrial implant in Stage III B cancer of the cervix. III. A five-year study.

Since 1975, the Department of Radiation Therapy, University of Maryland Hospital initiated a policy of supplementing the dose to the affected parametrium by using radium needles implants in conjunction with a protruding tandem preferably, or Manchester ovoid in the case of absence of the lower segment of the uterus. The authors have noted a remarkable improvement in local control as well as an improved three-year survival rate with minimal immediate complications. Additional Stage IIIB (FIGO) cases were collected and they were treated by the same technique and have a close follow-up since 1975. Forty-nine cases studied, 32 (65%) survived with disease-free status for a minimum of five years with no loss to follow-up. Local control was excellent, as expected, at the level of 84% (41/49). There were 8% major complications as a consequence of radiation treatment and the majority of them required surgical intervention with excellent success. Paraaortic metastasis remains a major problem and requires further study. The current plan will include retroperitoneal exploratory laparotomy and para-aortic node sampling with extension of the external beam portals to include the positive node region and followed by interstitial and intracavitary brachytherapy.