Patter of care study and evidence based medicine for radiotherapy of cervical cancer

Radiotherapy for cervical cancer has become increasingly sophisticated with many clinical results. However, most radiation therapy techniques have been based on single institutional experiences. These centers of excellence have a large experience with radiation for cervical cancer and continue to evaluate their techniques and outcome. The Patterns of Care Study (PCS) in the United States conducted two national surveys of patients treated in 1973 and 1978 for squamous cell cancer of the uterine cervix. In this study, the only treatment factor associated with improved pelvic control in multivariate analysis was the use of intracavitary irradiation. A dose response for infield pelvic control was demonstrated only in Stage III cervical cancer with the highest rate of pelvic control with paracentral (PCS point A) dose greater than 8,500 cGy. In Japan, the influence of age on the process of radiotherapy for cervical cancer was analyzed with PCS. Lower pelvic radiation doses were used for the elder patients with advanced stage disease. Brachytherapy was used less commonly in the elderly group than in younger one. As a result, preliminary survival rates for the elderly were similar to those for the younger group. The representative guideline for treating cervical cancer that is evaluated as EBM is proposed by NCI. However, this guideline shows only the strategy and do not show the practical treatment methods. It must be kept in mind that there are several pitfalls to evaluate the treatment outcome for cervical cancer as EBM.