Prognostic factors in XXXX : implications in staging and management.

@entity1 @entity5 @entity26 @entity2622 @entity189 @entity519
Individualization of treatment using judicious combinations of external and intracavitary irradiation remains the cornerstone of the radiation management of @entity189 . The inherent propensity of this @entity5 to either confine itself to the pelvis or else spread in a systematic and predictable manner through lymphatic channels has facilitated its therapeutic control. The treatment of most early invasive @entity2622 is equally advantageous using either intracavitary radium or surgery. However, certain Stage I @entity1 have morphologic and histologic characteristics that militate against @entity5 control. Factors such as @entity5 size, depth of invasion, vascular infiltration, uterine extension, and barrel-shaped presentation affect the course of the disease and survival. A clinical-pathologic staging for @entity2622 incorporating the above mentioned factors into the current clinical FIGO staging system has been suggested. It aims to facilitate the recognition of those @entity5 that require additional external radiotherapy. A description of the role of surgery, intracavitary and external radiation, and their combinations is included. In advanced @entity189 , failure can be attributed to either @entity5 containing cores of @entity519 cells resistant to conventional radiation therapy or to uncontrolled subclinical disease in the lymphatics at or near the border of the irradiated area. Radiotherapy combined with surgery, @entity26 enhancers, infusion chemotherapy, and large particle high LET radiation has been implemented to increase local control; for distal failures, extended field irradiation of paraaortic nodes has been found to be technically feasible and well tolerated and is being studied for its effects on increased survival. The rationale for newer treatment procedures, including preliminary results and their complications, is discussed.
