An analysis of the records of 916 patients who received radiotherapy for invasive squamous cell carcinoma of the intact uterine cervix from January 1964 through December 1969 revealed that 94% of the central and regional failures will occur within 3 years of treatment. Survival rates were as follows: Stage I, 91%; Stage IIA, 82%; Stage IIB, 65%; Stage IIIA, 54%; and Stage IIIB, 40%. The incidences of central and regional failures in Stages I through III are: Stages I and IIA; central 2% and regional 4.5%; Stage IIB; central 5% and regional 13%; Stage III: central 14% and regional 19%. In stages IIB, IIIA, and IIIB, the main cause of failures, either centrally or in the parametria, is the presence of massive disease.

A number of patients with cancer later develop metastases in the draining lymphatics, which initially were clinically negative. These occult deposits represent subclinical disease in lymphatic areas accessible to palpation, like the neck, axillae, and groin. The concept applies also to the microscopic disease left in an area after a surgical procedure is known to have removed all gross cancer, yet some patients later develop a recurrence. The term “subclinical disease” refers only to disease in a specific anatomic area, based on clinical facts. Radiobiological parameters account for the fact that subclinical disease requires less irradiation to be eradicated than gross cancer. The concept has two main applications, elective irradiation of clinically negative peripheral lymphatics and locoregional irradiation combined with surgery, which are determined by site and disease. The concept of subclinical disease also has implications for chemotherapy, which bear a direct relationship between chemotherapy both with radiation therapy and surgery. Cancer 53:1274‐1284, 1984.

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