Analysis of the Clinical-Epidemiological Profile and Cytopathological Follow-Up of Women with Cervical Cancer Undergoing Radiotherapy

Main Article Content

Catia Martins Leite Padilha Lucas Gomes Padilha Filho Rosana da Paz Ferreira Sergio Augusto Lopes de Souza


The objectives of this study were to identify the clinical-epidemiological profile of patients undergoing radiotherapy for malignant neoplasia of the cervix; describe the main cytological changes induced by radiation during post-radiotherapy follow-up; verify the incidence of locoregional recurrence, according to the cytopathological diagnosis and identify the disease-free survival and overall survival of patients followed in the study. The methodological design had a descriptive approach with a quantitative nature and longitudinal character, whose population was composed of 407 patients with cervical cancer who underwent radiotherapy and were followed up for a minimum of 5 years and a maximum of 7 years. The project was approved by the Research Ethics Committee of the National Cancer Institute, Rio de Janeiro, Brazil. Sociodemographic variables and associated risk factors were evaluated; categorical variables (cytopathological) and dependent variables for the outcome of locoregional recurrence, death and disease-free survival. The epidemiological profile of the study population revealed a mean age of 51 years, with an age range primarily from 41 to 50 years, with risk factors associated with smoking being present in 32% of patients. The percentage of alcoholics was just 5.5%. Regarding the number of sexual partners, the average was 4 partners throughout life. Squamous cell carcinoma was the most common histological type (84%). Regarding clinical staging, 2B (42.9%) and 3B (33.7%) were predominant. Of the exams with satisfactory quality for analysis, more than half (64.9%) showed actinic effects. The incidence of locoregional recurrence, according to the cytopathological diagnosis, was 11.8%, of which almost half (47.9%) died. The analysis of locoregional recurrence that impacts disease-free survival was 69.5%. The overall survival found in the analyzed population was 75.7%. The difficulties related to actinic (radiotherapy) effects show the importance of the experience of professionals involved in the analysis of irradiated cells and reflection on the subjectivity of the method. Observing these changes is useful for evaluating the impact of actions taken during the period and planning future actions.

Keywords: Actinic Effects, Radiotherapy, Uterine Cervical Cancer, Cytopathology

Article Details

How to Cite
PADILHA, Catia Martins Leite et al. Analysis of the Clinical-Epidemiological Profile and Cytopathological Follow-Up of Women with Cervical Cancer Undergoing Radiotherapy. Medical Research Archives, [S.l.], v. 11, n. 10, oct. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 29 nov. 2023. doi:
Research Articles


1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
2. Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors. Eur J Cancer. 2013;49(15):3262-3273. doi: 10.1016/j.ejca.2013.04.024
3. World WHO, Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Accessed September 3, 2023.
4. Ferreira MDCM, Nogueira MC, Ferreira LDCM, Bustamante-Teixeira MT. Early detection and prevention of cervical cancer: knowledge, attitudes and practices of FHS professionals. Ciênc Saúde Coletiva. 2022;27(6):2291-2302. doi:10.1590/1413-81232022276.17002021
5. Corrêa FM, Migowski A, De Almeida LM, Soares MA. Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination. Front Med. 2022;9:945621. doi:10.3389/fmed.2022.945621
6. Nogueira-Rodrigues A. HPV Vaccination in Latin America: Global Challenges and Feasible Solutions. Am Soc Clin Oncol Educ Book. 2019;(39):e45-e52. doi:10.1200/EDBK_249695
7. Thuler LCS, Aguiar SSD, Bergmann A. Determinants of diagnosis in advanced stages of cervical cancer in Brazil. Rev Bras Ginecol E Obstetrícia. 2014;36(6):237-243. doi:10.1590/S0100-720320140005010
8. Yuan G, Wu L, Huang M, Li N, An J. A phase II study of concurrent chemo-radiotherapy with weekly nedaplatin in advanced squamous cell carcinoma of the uterine cervix. Radiat Oncol. 2014;9(1):55. doi:10.1186/1748-717X-9-55
9. Yu C, Peng RY. Biological effects and mechanisms of shortwave radiation: a review. Mil Med Res. 2017;4:24. doi:10.1186/s40779-017-0133-6
10. Padilha CML, Araújo MLC, Souza SAL de. Cytopathologic evaluation of patients submitted to radiotherapy for uterine cervix cancer. Rev Assoc Médica Bras. 2017;63:379-385. doi:10.1590/1806-9282.63.04.379
11. Chino J, Annunziata CM, Beriwal S, et al. Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2020;10(4):220-234. doi: 10.1016/j.prro.2020.04.002
12. Zannoni GF, Vellone VG, Carbone A. Morphological effects of radiochemotherapy on cervical carcinoma: a morphological study of 50 cases of hysterectomy specimens after neoadjuvant treatment. Int J Gynecol Pathol Off J Int Soc Gynecol Pathol. 2008;27(2):274-281. doi:10.1097/PGP.0b013e31815b1263
13. Bibbo M, Wilbur D, eds. Comprehensive Cytopathology. 3. ed. Saunders, Elsevier; 2008.
14. Gupta S, Sodhani P. Why is high grade squamous intraepithelial neoplasia under-diagnosed on cytology in a quarter of cases? Analysis of smear characteristics in discrepant cases. Indian J Cancer. 2004;41(3):104-108.
15. Rose PG, Bundy BN, Watkins EB, et al. Concurrent Cisplatin-Based Radiotherapy and Chemotherapy for Locally Advanced Cervical Cancer. N Engl J Med. 1999;340(15):1144-1153. doi:10.1056/NEJM199904153401502
16. Koss, L, Melamed, MR. Diagnostic Cytology and Its Histopathologic Bases. Edition: 5th Ed. Lippincott Williams & Wilkins (LWW); 2005.
17. Ferreira M do C, Vale DB, Barros MB de A. Incidence and mortality from breast and cervical cancer in a Brazilian town. Rev Saúde Pública. 2021;55:67. doi:10.11606/s1518-8787.2021055003085
18. Levine EM Ginsberg NA, Fernandez CM. Age and Cervical Cancer Screening Recommendations. Med Res Arch. 2021;9(4). doi:10.18103/mra.v9i4.2375
19. Colares WTHC, Nunes GPS, Reinehr TA, et al. Clinical-epidemiological analysis of cervical cancer in Manaus: Relationship between age and staging. Braz J Health Rev. 2020;3(6):16510-16517. doi:10.34119/bjhrv3n6-072
20. Rama C, Roteli-Martins C, Derchain S, et al. Previous screening for cervical cancer among women with cytological and histological abnormalities. Rev Saúde Pública. 2008;42(3):411-419. doi:10.1590/S0034-89102008000300004
21. Barreto CL. Sobrevida e fatores de prognóstico em pacientes com câncer invasivo do colo uterino. Published March 9, 2012. Accessed September 4, 2023.
22. Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 2000;48(1):201-211. doi:10.1016/s0360-3016(00)00497-1
23. Eifel PJ, Moughan J, Erickson B, Iarocci T, Grant D, Owen J. Patterns of radiotherapy practice for patients with carcinoma of the uterine cervix: a patterns of care study. Int J Radiat Oncol Biol Phys. 2004;60(4):1144-1153. doi:10.1016/j.ijrobp.2004.04.063
24. Erickson B, Eifel P, Moughan J, Rownd J, Iarocci T, Owen J. Patterns of brachytherapy practice for patients with carcinoma of the cervix (1996-1999): a patterns of care study. Int J Radiat Oncol Biol Phys. 2005;63(4):1083-1092. doi: 10.1016/j.ijrobp.2005.04.035
25. Green JA, Kirwan JJ, Tierney J, et al. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, ed. Cochrane Database Syst Rev. Published online July 20, 2005. doi:10.1002/14651858.CD002225.pub2
26. Shield PW. Chronic radiation effects: A correlative study of smears and biopsies from the cervix and vagina. Diagn Cytopathol. 1995;13(2):107-119. doi:10.1002/dc.2840130206
27. Silva RCG, Figueirêdo RDPV, Silva ACO, Lima CEQ, Oliveira SR, Peres AL. Cytopathologic follow-up of women with cervical cancer post-radiotherapy: case series. J Bras Patol E Med Lab. 2018;54(2). doi:10.5935/1676-2444.20180018
28. CML Padilha, Diré GD, Padilha Filh LG. Analysis of Actinic Effect after Radiotherapy in the Uterine Col Carcinomas. J Am Sci. 2005;1(1).
29. Pangarkar MA. The Bethesda System for reporting cervical cytology. Cytojournal. 2022; 19:28. doi:10.25259/CMAS_03_07_2021
30. Shakespeare TP, Lim KHC, Lee KM, Back MF, Mukherjee R, Lu JD. Phase II study of the American Brachytherapy Society guidelines for the use of high-dose rate brachytherapy in the treatment of cervical carcinoma: is 45-50.4 Gy radiochemotherapy plus 31.8 Gy in six fractions high-dose rate brachytherapy tolerable? Int J Gynecol Cancer. 2006;16(1):277-282. doi:10.1111/j.1525-1438.2006. 00373.x
31. Shield PW, Wright RG, Free K, Daunter B. The accuracy of cervicovaginal cytology in the detection of recurrent cervical carcinoma following radiotherapy. Gynecol Oncol. 1991;41(3):223-229. doi:10.1016/0090-8258(91)90313-T
32. Mayer Á, Nemeskéri C, Petneházi C, Borgulya G, Varga S, Naszály A. Primary Radiotherapy of Stage IIA/B–IIIB Cervical Carcinoma: A Comparison of Continuous Versus Sequential Regimens. Strahlenther Onkol. 2004;180(4):209-215. doi:10.1007/s00066-004-1122-8
33. Windschall A, Ott OJ, Sauer R, Strnad V. Radiation Therapy and Simultaneous Chemotherapy for Recurrent Cervical Carcinoma. Strahlenther Onkol. 2005;181(8):545-550. doi:10.1007/s00066-005-1340-8

Most read articles by the same author(s)