From June 1977 to June 1983, 32 patients with bulky (greater than 4 cm diameter), barrel-shaped Stage IB
cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron
brachytherapy using
californium 252 (252Cf) and external pelvic radiation followed by extrafascial
hysterectomy. Nineteen patients had cervical
tumors 4 to 6 cm in diameter, and 13 patients had lesions in excess of 6 cm in diameter. A dose of 4500 rad external photon
therapy was given from a
linear accelerator, and one or two 6-hour 252Cf implants were given during or immediately after external radiation. Extrafascial
hysterectomy with bilateral
salpingo-oophorectomy was performed 6 weeks after completion of
radiation therapy. Complications during and after radiation were minimal and included vaginal
stenosis (three) and
proctitis (two).
Tumor clearance in the
hysterectomy specimen was complete in 23 patients (72%) and residual cervical
tumor was present in 9 patients (28%). Two patients developed
tumor recurrence and died of disease 15 and 27 months after
therapy, respectively. Thirty patients remain free of disease 26 to 96 months (median, 52 months)
after treatment, and none have been lost to follow-up. The actuarial survival of these patients is 97% at 2 years and 94% at 5 years. Intracavitary neutron
therapy is well tolerated and is effective when combined with external radiation and
hysterectomy in the treatment of bulky, barrel-shaped Stage IB
cervical cancer.