食管癌放疗后生存10年患者的临床分析

总结 1970～ 1984年间 10 0例存活 10年以上经单纯放疗的食管癌病例。 3野或 4野交叉照射 ,总剂量为 5 0～ 70 Gy。 10 0例中 9例接受再程放疗 ,现生存 5 8例 ,死亡 4 2例 ,其中死于局部复发、大出血、穿孔者分别为 18,6 ,4例。5 8例生存者中 5例放射性脊髓炎 ,3例放射野区肋骨骨折。结论 :年轻患者预后好 ,髓质型、蕈伞型预后相对较好 ,疗后锁上转移再放疗后可以长期生存 ,局部复发仍为主要死亡原因 ,总剂量以 5 0～ 70 Gy为宜 ,脊髓量应严格控制 ,提高照射技术 ,防止远期副作用 ,提高生存质量。     

鼻咽癌调强放疗中再程计划保护腮腺对口干燥症影响的临床研究

摘 要：［目的］ 研究鼻咽癌调强放疗中再程计划改野对减轻腮腺损伤,降低口干燥症发生率的影响。［方法］ 入组117例拟行调强放疗的鼻咽癌患者,分单次计划放疗组（46例）和再程计划放疗组（71例）。对两组靶区受照射剂量和体积、双侧腮腺受照射剂量和体积、4年局部控制率和4年生存率进行比较。［结果］ 两组靶区受照射剂量及体积变化差异无统计学意义（P＞0.05）,但再程计划放疗组双侧腮腺受照射剂量和体积均较单次计划放疗组显著降低（P＜0.05）。再程计划放疗组口干燥症严重程度较单次计划放疗组低（P=0.015）。再程计划放疗组和单次计划放疗组的4年局部控制率分别为94.4%和82.6%（P=0.046）,4年总生存率分别为84.5%和80.4%（P=0.573）。［结论］ 鼻咽癌调强放疗中再程计划改野模式可减轻腮腺损伤,降低口干燥症的发生。     

10例放射性肺炎临床分析

198 7年 1月～ 1988年 12月放射治疗 2 30例肺癌、乳腺癌患者。其中肺癌 135例 ,乳腺癌 95例。发生放射性肺炎分别为 5 .1% (7/ 135 )、3.1% (3/ 95 )。并胸水患者行全胸移动条野照射 16例 ,发生放射性肺炎 31.2 % (5 / 16 )。而常规照射野占 2 .3% (5 / 2 14)。放射性肺炎的发生与靶区剂量、照射面积为正比关系 ,化疗后再放疗发生率明显增高。     

乳腺癌根治术后放射治疗胸壁及腋窝的临床意义

目的　探讨乳腺癌根治术后放射治疗胸壁、腋窝的临床意义。方法　资料完整 ,经过随访病例 14 6例 ,其中ⅡA4 7例 ,Ⅱb5 3例 ,ⅢA38例 ,Ⅲb8例。合并胸壁放疗组 4 6例 (胸壁组 ) ;放疗锁骨上区、内乳区 5 0例(2野组 ) :放疗锁骨上区、内乳区及腋窝 5 0例 (3野组 )。每野照射剂量 5 0 - 5 5GY ,5 0～ 5 6周完成。结果　1、3、5年局部控制率 (包括胸壁、锁骨上区、内乳区腋窝 ) ,胸壁组分别为 98 0 %、95 5 %、95 5 % ;2野组分别为 87 8%、82 4 %、79 4 % ,3野组分别为 91 5 %、84 2 %、80 8%。胸壁组与 2野组比 χ2 =4 5 2 4 (P <0 0 5 ) ;胸壁组与 3野组与 χ2 =3.4 86 (P =0 .0 5 6 )。胸壁复发率 :胸壁组为 2 2 % ,未照射胸壁 (2野组 +3野组 )者为13% ,χ2 =4 2 5 9(P <0 0 5 )。腋窝复发率 :2野组不照射腋窝 ,3野组照射腋窝 ,复发各为 8%、2 % ,(P >0 0 0 5 ) ,患侧上肢水肿发生率各为 14 %、38% ,(P <0 0 1)。 1、3、5年生存率 ,胸壁组分别为 97 8%、85 1%及80 3% ;2野组分别为 95 1%、83 4 %及 71 7% ;3野组分别为 93 8%、82 9%及 6 5 7%。胸壁组与 2野组、3野组相比 ,P均 >0 0 5。远处转移 ,胸壁组 10 8% ,2野组 8 0 % ,3野组 10 % ,P均 >0 0 5。结论　胸壁放射治疗 ,可明显     

鼻咽癌放疗后张口困难的临床观察与分析

 目的　观察鼻咽癌患者放疗后张口困难情况 ,探讨影响放疗后张口困难的有关因素。方法　15 8例鼻咽癌患者中 32例用 8MV X线照射 ,5 5例用 6MV X线照射 ,71例用60 Coγ线照射 ,鼻咽原发病灶均采用面颈联合野常规分割照射 ,总剂量在DT( 6 5～ 80 )Gy总治疗时间 5 0～ 6 0天。以门齿距为观察张口困难的指标 ,用SOMA标准判定张口困难的程度。组间差异采用卡方检验。结果　全组张口困难发生率 2 4 .7% ,其中重度张口困难发生率为 0 .7%。放疗剂量为DT <70Gy、( 70～ 75 )Gy和 >75Gy的病人张口困难发生率分别为 11.2 %、2 6 .2 %和 4 0 .9% (P <0 .0 5 )。年龄 <4 6岁者和 >4 6岁者张口困难发生率分别为 17.8%和 31.7% (P <0 .0 5 )。坚持张口锻练者和未坚持张口锻练者张口困难发生率分别为2 0 .7%和 31.2 % (P <0 .0 5 )。结论　鼻咽癌放疗后张口困难是较常见的后遗症 ,一般发生在放疗后 3年内 ,重度张口困难发生率较低。颞颌关节和咀嚼肌群受照剂量、患者年龄和放疗后是否坚持张口...     

局限期小细胞肺癌胸部放疗靶区的前瞻性随机对照研究

目的 通过开展前瞻性随机对照研究探讨局限期小细胞肺癌(SCLC)胸部不同放疗靶区对预后的影响。方法 选取2002-2017年中山大学肿瘤医院及浙江省肿瘤医院收治的接受2程EP方案诱导化疗后无疾病进展的309例局限期SCLC患者。随机分为照射化疗后残留肿瘤组(159例)和照射化疗前原发病灶组(150例)。2个组患者均采用累及野照射纵隔阳性淋巴结的完整结区。胸部放疗采用45 Gy分30次3周完成,2 次/d,与第3程EP方案化疗同步进行。共化疗4-6程。放化疗后疗效评价完全缓解及部分缓解的患者接受全脑预防性放疗25 Gy分10次2周完成或30 Gy分15次3周完成。采用Kaplan-Meier法分析生存数据。结果 照射化疗后残留肿瘤组和化疗前原发病灶组1、2、5年局部控制率分别为79.4%、61.5%、60.1%和79.8%、66.5%、57.3%(P=0.73)。化疗后残留肿瘤组和化疗前原发病灶组中位生存时间分别为22.1个月(95%CI:18.2~26.0)和26.9个月(95%CI:23.5~30.3),1、3、5、7年总生存率分别为81.1%、31.6%、23.9%、 22.2%和85.3%、36.6%、26.1%、20.0%(P=0.51)。化疗后残留肿瘤组和化疗前原发病灶组2-3级急性放射性食管炎发生率分别为32.9%和43.2%(P=0.01),2-3级肺纤维化发生率分别为2.0%和10.9%(P=0.01)。结论 对于诱导化疗后的局限期SCLC,胸部放疗可仅照射化疗后残留原发灶,纵隔淋巴结引流区可常规采用累及野放疗。     

鼻咽癌不同设野或不同分割放疗方式放射反应比较

 目的　比较不同照射野或不同剂量分割放疗鼻咽癌的急性放射反应及后遗症。方法　耳前野不同分割方法两组各 30例 ,面颈联合野不同分割方法两组各 5 0例进行比较。结果　 (1)面颈联合野照射者消化道及咽粘膜反应均重于耳前野者 (P <0 .0 5或 0 .0 1) ,后遗症无显著性差别 (P >0 .0 5 ) ;(2 )后程加速超分割与常规分割放疗的急性放射反应及后遗症无显著性差异 (P >0 .0 5 )。结论　后程加速超分割放疗不明显增加急性放射反应及后遗症 ,面颈联合野急性放射反应加重。     

鼻咽癌局部复发再放疗的治疗技术及结果

本文报道麻省总医院1950～1980年间,鼻咽癌根治性放疗后、局部复发再放疗的51例病人的治疗情况。 鼻咽癌初程放疗采用大剂量分隔治疗如腔内治疗,原发灶很少出现复发,对于早期病变的局部控制率超过80％。 鼻咽癌局部复发病变用4MV～X多野照射,根据病变范围,选用旋转照射加腔内治疗,或两侧野加旋转照射。38例再放疗60Cy或更高剂量,有7例生存10年或10年以上,其中3例超过20年,5年和10年生存率分别为45％和39％,13例低于60Cy的,     

460例巨大肝癌放射治疗的技术改进

目的：总结改良的全肝移动条野放射＋缩野技术＋分段放射治疗技术,探讨在巨大肝癌放射治疗中的意义.方法：收集1987～2001年本院460例巨大肝癌放射治疗资料进行回顾性分析.按放疗剂量分为3组.结果：1组：全肝移动条野照射2轮,mTD16～19Gy共260例,临床受益率81.5%,中位生存期8个月.2组：全肝移动条野照射3～4轮,mTD24～35Gy共127例,临床受益率90.5%,中位生存期11个月.3组：全肝移动条野照射＋缩野技术＋分段放疗,mTD50～60Gy共73例,肿瘤明显缩小40.0%～50.0%以上,临床受益率100.0%,1、3和5年生存率分别为95.8%、47.9%和10.9%,其中10例肿瘤缩小后二步切除,5年生存率为40.0%,10年生存率30.0%,最长生存者18年仍健在.结论：全肝移动条野放射＋缩野技术＋分段放疗是安全、有效的肝癌治疗技术,临床受益率高,少数患者可获根治.     

106例放射性肺炎相关因素分析

目的 回顾性分析肺癌放射治疗后并发放射性肺炎的发生率,了解发生的相关因素.方法自1995年1月～2004年12月期间我科收治的793例肺癌病人.采有钴60或直线加速器6-10 MV X线外照射,常规分割,DT4 600 CGY-7 200 CGY/23～36 F.照射野面积大于120 cm2 547例.剂量大于5 000 CGY的680例.结果放射性肺炎发生率为13.4%.照射野面积大于120 cm2,剂量大于5 000 CGY的放射性肺炎发生率分别为16.2%和14.6%.结论放射治疗引起的放射损伤应引起高度重视,照射野面积大,剂量高,放射性肺炎的发生率高.     

三维适形放疗结合TACE在结直肠癌患者根治术后肝转移的临床应用

目的：探讨对于不宜或不能手术治疗的结直肠癌肝转移灶行TACE后根治性三维适形放射治疗的可行性,不良反应及疗效。方法：对20例结直肠癌根治术后出现肝转移灶的病人,行TACE（ADM＋碘油）后3周内,针对其肝转移灶行三维适形放疗,常规分割2Gy,总剂量60—66Gy。结果：4例（20％）患者出现Ⅲ度恶心呕吐,3例（15％）出现Ⅲ度中性粒细胞减少,1例（5％）出现Ⅲ度血小板减少,4例（20％）出现Ⅲ度肝功能异常。治疗结束后,4例（20％）CR,11例（55％）PR,5例（25％）SD,无1例进展,有效率为75％。结论：对于结直肠癌根治术后出现不宜或不能手术的肝转移癌,应用三维适形放疗结合TACE的治疗模式,是可行的,无严重不良反应,近期疗效显著。     

Second acute leukemia and other malignancies following treatment for Hodgkin's disease

The records of 1,329 patients with Hodgkin's disease admitted from 1965 to 1982 were analyzed to assess the relative frequency of second neoplasms. Within a median follow-up of 9.5 years, a total of 68 new cancers were documented. Nineteen cases of acute nonlymphocytic leukemia, 6 cases of non-Hodgkin's lymphomas, and 43 cases with different types of solid tumors were identified. The overall risk of non-Hodgkin's lymphoma was 1.3% +/- 0.6% and of solid tumors was 8.3% +/- 1.5% when basal cell carcinomas were included and 6.7% +/- 1.4% when basal cell carcinomas were excluded. No cases of leukemia were documented in patients treated with radiation therapy only. The 12-year estimate of leukemia by treatment was as follows: chemotherapy only 1.4% +/- 2.3%; radiation plus MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) 10.2% +/- 5.2%; radiation plus ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) 0; and radiation plus other drug regimens 4.8% +/- 1.6%. The risk of leukemia was particularly high (15.5% +/- 7.4%) in patients who received salvage MOPP after radiation failure. A positive association was also noted between increasing age and risk of second malignancies, especially leukemia. The incidence of second neoplasms can be markedly decreased by deleting from potentially curative therapy certain drugs such as alkylating agents, procarbazine, and nitrosourea derivatives.     

颈静脉球瘤的三维立体适形放疗3例报告

目的：探讨三维立体适形放疗治疗颈静脉球瘤的临床疗效.方法：回顾性分析3例颈静脉球瘤的临床资料,3例均采用三维立体适形放疗,肿瘤体积约2-8cm3,肿瘤DT达45-55Gy/9-11f/3-3.5w,随访1-8年.结果：1例头痛、头晕、耳鸣、耳聋等症状完全缓解,复查颅脑增强MRI显示病灶明显缩小;1例耳鸣、头痛、头晕、手足震颤、出汗均消失,继发性高血压自愈,复查颅脑增强MRI显示病灶缩小;1例耳鸣减轻,颅脑CT显示肿瘤稳定.随访后病情均稳定,无复发或转移.结论：三维立体适形放疗能较好的控制肿瘤生长,无明显不良反应,可作为不适合手术、拒绝手术的颈静脉球瘤病人首选的治疗方法,同时也是术后肿瘤残留或复发的重要治疗手段.     

三维适形放射治疗25例肝癌临床分析

目的评价肝癌用三维适形放射治疗的疗效。方法对25例肝癌患者采用三维适形放射治疗,原发性肝癌16例,转移性肝癌9例;7例曾行1。2次介入治疗。肿瘤体积2．91～685．9cm^3,平均125．25cm^3,中位体积14．05cm^3。设3—5个共面等中心照射野,80％。90％的等剂量线包绕PTV,靶区包括肿瘤边缘外0．5～1．5cm,用6MV—X线照射,总量为DT43．2—54Gy,2．25—3．6Gy／F,每周5次,放疗结束后1-2个月复查CT。结果本组25例,CR5例（20％）,PR14例（56％）,SD5例（20％）,PD1例（4％）,有效率CR＋PR为76％。结论三维适形放射治疗适用于肝癌的治疗,不良反应小,效果明显,但制订治疗计划时应充分考虑放射性肝病的发生概率。     

Staging, therapy and prognosis of primary non-Hodgkin's lymphoma of bone and a comparison of results with localized Ewing's sarcoma: ten years experience at the Istituto Ortopedico Rizzoli

Thirty consecutive cases of localized primary non-Hodgkin's lymphoma of bone (PNHLB) were treated in a 10-year period at the Istituto Ortopedico Rizzoli with localized radiation (4 cases) and localized radiation and adjuvant chemotherapy (26 cases). The doses of radiation varied from 3000-4500 rad. A variety of staging procedures evolving with new diagnostic techniques over the 10 years were performed. Adjuvant chemotherapy comprised two different regimens of vincristine, adriamycin and cyclophosphamide. Twenty-four of the 26 patients (92%) have been free of disease with a median follow-up of 75.5 months (18-144 months). Two patients developed meningeal involvement and one patient, treated with radiation therapy only, developed a local recurrence. The results are compared to the management of 68 Ewing's sarcoma patients treated during the same period. Here, higher doses of localized radiation therapy (approximately 5000 rad) and similar adjuvant chemotherapy were administered. The survival was 32% (22/68) with a higher incidence of local recurrence (21%). These data indicate that PNHLB should be considered a separate entity from Ewing's sarcoma and can be treated successfully with lower doses of radiation to the primary tumor and adjuvant chemotherapy. The observations are also compared to a variety of other biological characteristics of Ewing's sarcoma. Since only two patients developed meningeal relapse, our experience does not permit a firm recommendation for routine prophylactic treatment of the central nervous system in PNHLB.     

Long-term results in 144 localized Ewing's sarcoma patients treated with combined therapy

The results of 144 previously untreated cases of primary Ewing's sarcoma of bone are reported with a minimum follow-up of 5 years. This series was treated between 1972 and 1982 at Istituto Ortopedico Rizzoli with a combined therapy. The local control of the disease consisted of amputation (ten cases), resection followed by radiation therapy (35-45 Gy) (48 cases) and radiation therapy alone (40-60 Gy) (86 cases). Adjuvant chemotherapy, rigorously standardized, was performed according two different protocols: the first (85 cases treated in the period 1972-1978) consisted of vincristine (VCR) Adriamycin (doxorubicin) (ADM), and cyclophosphamide (EDX); the second (59 cases treated in the period 1979-1982) of VCR, ADM, EDX and dactinomycin (DACT). At a follow-up of 5 to 16 years (median, 9), 59 patients (41%) are continuously disease-free (CDF), 81 (56%) developed metastatic disease and/or local recurrence, and four (3%) had a second malignancy. Three factors seem to be correlated to prognosis: the site of the initial lesion (only 23% of the pelvic lesions are represented in the CDF group versus 46% of the other locations); the chemotherapy protocol (32% of the cases in the first protocol are CDF versus 54% in the second); the type of local treatment (60% of the patients treated with amputation or resection plus radiotherapy versus 28% of those treated with radiation therapy alone are CDF). A local recurrence was observed in 24% of the patients (8% in the group locally treated with surgery or surgery plus radiation therapy versus 36% in the group treated with radiation therapy alone). These data suggest that even though adjuvant chemotherapy can improve the long-term results in localized Ewing's sarcoma patients, this disease still represents, in a high percentage of cases, a lethal process whose final prognosis widely depends on the local control of the lesion. Due to the questionable effect of the radiation therapy alone in controlling the primary lesion and its important side effects, the role of surgery in treating Ewing's sarcoma of bone should be extended.     

Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy

The likelihood of radiation pneumonitis and factors associated with its development in breast cancer patients treated with conservative surgery and radiation therapy have not been well established. To assess these, we retrospectively reviewed 1624 patients treated between 1968 and 1985. Median follow-up for patients without local or distant failure was 77 months. Patients were treated with either tangential fields alone (n = 508) or tangents with a third field to the supraclavicular (SC) or SC-axillary (AX) region (n = 1116). Lung volume treated in the tangential fields was generally limited by keeping the perpendicular distance (demagnified) at the isocenter from the deep field edges to the posterior chest wall (CLD) to 3 cm or less. Seventeen patients with radiation pneumonitis were identified (1.0%). Radiation pneumonitis was diagnosed when patients presented with cough (15/17, 88%), fever (9/17, 53%), and/or dyspnea (6/17, 35%) and radiographic changes (17/17) following completion of RT. Radiographic infiltrates corresponded to treatment portals in all patients, and in 12 of the 17 patients, returned to baseline within 1-12 months. Five patients had permanent scarring on chest X ray. No patient had late or persistent pulmonary symptoms. The incidence of radiation pneumonitis was correlated with the combined use of chemotherapy (CT) and a third field. Three percent (11/328) of patients treated with a 3-field technique who received chemotherapy developed radiation pneumonitis compared to 0.5% (6 of 1296) for all other patients (p = 0.0001). When patients treated with a 3-field technique received chemotherapy concurrently with radiation therapy, the incidence of radiation pneumonitis was 8.8% (8/92) compared with 1.3% (3/236) for those who received sequential chemotherapy and radiation therapy (p = 0.002). A case:control analysis was performed to determine if the volume of lung irradiated (as determined using central lung distance [CLD]) was related to the risk of developing radiation pneumonitis. Three control patients were matched to each case of radiation pneumonitis based on age, side of lesion, chemotherapy (including sequencing), use of a third field, and year treated. Lung volumes were similar in the radiation pneumonitis cases and controls. We conclude that radiation pneumonitis following conservative surgery and radiation therapy for breast cancer is a rare complication, and that it is more likely to occur in patients treated with both a 3-field technique and chemotherapy (particularly given concurrently with radiation therapy). Over the limited range of volumes treated, lung volume was not associated with an increased risk of radiation pneumonitis.     

Carcinoma of the superior pulmonary sulcus treated with surgery and/or radiation therapy

This is a retrospective analysis of 50 patients with carcinoma of the superior pulmonary sulcus, treated with curative intent at the University of Florida between October 1964 and October 1981. Treatment groups included preoperative radiation therapy and surgery (40 patients), radiation therapy alone (7 patients), and surgery with postoperative radiation therapy (3 patients). There was a minimum 2-year follow-up. Local control was obtained in 8 of 26 evaluable patients (31%) treated with preoperative radiation therapy and surgery, 2 of 6 patients treated with radiation therapy alone, and 0 of 2 patients treated with surgery and postoperative radiation therapy. Twelve (30%) of 40 patients receiving planned preoperative radiation therapy did not undergo definitive surgery. Absolute survival free of disease at 5 years by treatment group for patients at risk was 3 of 30 (10%) with preoperative radiation therapy and surgery, 0 of 3 with surgery and postoperative radiation therapy, and 2 of 7 with radiation therapy alone. Since one third of the patients who received low- to moderate-dose preoperative radiation therapy did not undergo definitive surgery, and since there is a small but significant survival with radiation therapy alone, it seems unwise to give moderate-dose preoperative radiation therapy, which implies an unfavorable radiation technique for the unresectable cases. The recommendation is to treat patients with lesions believed to be resectable by initial surgical resection followed by high-dose radiation therapy in selected patients with questionable margins or positive lymph nodes. Those patients with borderline or apparently unresectable lesions are recommended to be treated with radiation therapy alone.     

高剂量三维适形放疗治疗非小细胞肺癌的临床观察

[目的]观察高剂量三维适形放疗治疗非小细胞肺癌的疗效和毒副反应.[方法]2001年3月至2003年10月采用三维适形放疗38例非小细胞肺癌患者,并与随机抽取的同期常规放疗的34例非小细胞肺癌患者对照,对比观察两组患者的近期疗效,1、2年生存率,中位生存期和毒副反应.[结果]两组有效率差异无显著性.经过6～32个月(中位时间16个月)随访,治疗组1、2年生存率,中位生存期分别为79.08%、49.60%、22个月,显著优于对照组的63.44%、25.10%、16个月(P=0.04).两组血液学毒性及急性放射肺、食管损伤发生率无显著性差异.[结论]高剂量三维适形放疗能提高非小细胞肺癌患者的生存率,急性放射损伤与常规放疗相似.     

Patterns of radiotherapy practice for patients with squamous carcinoma of the uterine cervix: patterns of care study

PURPOSE: To determine the impact of research findings and evolving technology on the patterns of radiotherapy practice for patients with carcinoma of the uterine cervix. METHODS AND MATERIALS: Sixty-two radiation therapy facilities participated in the study after having been selected from a random sample, proportionally stratified according to practice type, of all United States facilities. Each facility submitted a list of patients treated during 1992-1994 with radiation for squamous carcinoma of the cervix. Cases for review were randomly selected from each institution after excluding those of patients who had distant metastases or initial hysterectomy. A total of 471 patients' records were reviewed in the treating institutions to obtain information about patients' characteristics, diagnostic evaluation, tumor extent, treatment approach, and radiotherapy techniques. RESULTS: Of the 61 facilities that treated eligible cases of intact cervical cancer during the 3-year survey period, 35 (57%) treated fewer than three eligible patients per year. Thirty-four (83%) of 41 non-academic facilities vs. 1 (5%) of 20 academic facilities treated fewer than three patients per year. FIGO stages were I, II, III, and IV in 32%, 40%, 24%, and 3% of patients, respectively. Computed tomography (CT) was the most common method of lymph node evaluation, but surgical evaluation, which was performed in 76 (16%) patients, had increased from previous surveys. Fields were designed using a dedicated simulator in 95% of patients; a dedicated CT unit was used for treatment planning in 119 (30%) cases. External beam irradiation was most often given using a four-field technique at 180 cGy per day on a 10-20 MV linear accelerator. The average daily fraction size had decreased from previous surveys, and 13% of patients were treated with daily doses of 170 cGy or less. Most patients were treated with a combination of external beam and low dose-rate (LDR) intracavitary irradiation. Of 425 patients who had treatment with curative intent that included brachytherapy, 362 (85%) had LDR brachytherapy, 45 (11%) had high dose-rate (HDR) brachytherapy, 3 had a combination of HDR and LDR, and 15 had incomplete information about the brachytherapy dose-rate. Forty-six (23%) of 197 patients with Stages I-IIA disease were treated with radiation followed by extrafascial hysterectomy. Of 111 patients treated with curative intent for Stage III-IV disease, 72 (65%) had a combination of external beam and intracavitary radiation therapy, 22 (20%) had external beam plus interstitial brachytherapy, and 17 (15%) were treated with external beam irradiation only. For patients who completed treatment with curative intent and did not have adjuvant hysterectomy or HDR brachytherapy, the median total dose at point A was 82.5 Gy. For all patients who completed treatment with radiation alone, the median total duration of treatment was 63 days; more than 70 days were taken to complete treatment in 33% of cases. Twenty-nine percent of patients received chemotherapy, usually concurrent with their radiation therapy. Only 27% of these patients were on investigational protocols. CONCLUSIONS: Greater participation in well-designed prospective trials might help clinicians address important clinical questions and reduce current inconsistencies in the use of adjuvant treatments. Radiation oncologists should take steps to avoid unnecessary treatment protraction and to improve patient compliance. Future studies will be needed to determine whether the small number of cases being treated in most nonacademic facilities will influence the outcome for patients with invasive cervical carcinoma.