Extended field irradiation for cervical cancer based on surgical staging

Surgical staging was done in 355 patients with carcinoma of the cervix. Periaortic node biopsies, peritoneal cytology, and/or biopsy were obtained to determine the need of extended field irradiation. Forty-one patients received extended field irradiation. On review, 38 of these patients were shown to have cancer in the periaortic nodes or peritoneal cavity. Of these patients, 5 have survived longer than 5 years, 3 with metastatic cancer in the periaortic nodes and 2 in the peritoneal cavity. Irradiation to extended fields was 4500 rad or less for the first 17 patients. Since then 5100 rad has been delivered at the rate of 850 rad per week. The incidence of bowel complications was not excessive, utilizing a suture technique to exclude small bowel from the pelvis. Control of the cancer occurred in one patient with massive metastatic periaortic disease. A safe and effective dosage level for radiation therapy has been established with the described limited surgical exploration.