POSTTREATMENT URETERAL OBSTRUCTION IN INVASIVE-CARCINOMA OF UTERINE CERVIX

There were 2,016 new cases of invasive carcinoma of the cervix (Stages I-IV) who were seen from January 1951 to January 1981, in LSU Medical Center. One thousand, one hundred and five cases were Stages I and II (early stages), and 911 cases were Stages III and IV (advanced stages). One hundred and thirty-seven cases of early stages (12%) were recorded to have ureteral obstruction that developed after completion of the treatment for cervical carcinoma. Ninety-four (69%) of the 137 patients with ureteral obstruction in early stages are dead, and autopsy information is available in 28 cases. There was evidence of cervical carcinoma causing ureteral obstruction in 13 autopsy cases. Of the 66 patients who died and were not autopsied, 26 cases had biopsy-proven evidence of either persistent or recurrent cervical carcinoma. All 43 patients surviving in this group are biopsy negative or clinically with no evidence of disease (NED). One hundred and sixty-three patients in advanced stages (18%) who did not have ureteral obstruction prior to definitive treatment for cervical carcinoma developed ureteral obstruction after completion of treatment. One hundred and forty-two (87%) of the 163 patients with ureteral obstruction in advanced stages are dead, and autopsy information is available in 36 cases. There was evidence of recurrent or persistent carcinoma causing ureteral obstruction in 25 cases (69%). Of the 106 patients who died and were not autopsied, 76 had biopsy-proven Ca (72%) in the pelvis and abdomen prior to death. In this group, 21 patients survived until January 1, 1985, and four of them had biopsy-proven Ca which caused ureteral obstruction. In both early and advanced stages, 13 patients with post-treatment ureteral obstruction were lost to follow-up, but the remaining 287 cases have been followed until death or at least 4 years after detection of the ureteral obstruction. The median follow-up was 64.2 months, and seven patients have survived beyond 10 years. This review shows that 12% of the patients with early stage and 18% with advanced stage carcinoma of the uterine cervix seen in this institution developed some degree of detectable ureteral obstruction. Biopsy-proven evidence of recurrent or persistent carcinoma indicating the Ca to cause posttreatment ureteral obstruction in early stages of cervical carcinoma was 40% and in advanced stages was 66%. Twenty-six percent (26%) of the patients who received combination of radiation treatment and surgery developed ureteral obstruction in contrast to 15% of the patients who received definitive radiation alone and 10% of the patients who were treated by surgery alone. The purpose of this study is to determine the incidence and survival rate of posttreatment ureteral obstruction in Ca of the cervix according to the stage and modality of treatment.