Prospective study of apoptotic index and mitotic index as a predictor of response to radiation in subjects of squamous cell carcinoma of uterine cervix treated by radical radiotherapy

Introduction: There exists a wide variation in the response of tumors to radiotherapy and prognosis from individual to individual after radiotherapy to carcinoma of uterine cervix in all stages. Before embarking on treatment one would like to be forearmed with the knowledge that the treatment outcome would be good. Apoptosis is an important mechanism in predicting response to radiotherapy in squamous cell carcinoma of uterine cervix. Objective: Prospective study to correlate the relation between markers of cell proliferation (MI), cell death (AI), and MI to AI ratio as an independent prognostic factors in patients of carcinoma of uterine cervix treated by radical radiotherapy. Materials and Methods: 56 evaluable subjects of squamous cell carcinoma of uterine cervix during the period from May 1999 to December 1999 were enrolled in the study and patients were followed for 2 years. Measurement of Apoptotic index (AI) and Mitotic Index (MI) was done by microscopic method only. All subjects received radiation to a dose of 70 Gy using standard technique. Results: Patients with Apoptotic Index (AI) less than median value of 0.75% and Mitotic Index (MI) greater than median value of 0.2% showed better response to radical radiation therapy at 2 years. However the difference is not statistically significant (p = 0.20 and 0.25 respectively). Patients with AI/MI less than median value of 0.3 showed better local as well as overall control of disease when compared to patients with AI/MI ratio greater than median value of 0.3. The difference is statistically significant (p = 0.03). Conclusions: Besides traditional prognostic factors like stage, lympho-vasular invasion, AI/MI ratio will provide a guide for response to radiotherapy and prognosis.