Combined chemoradiation (CRT) with high dose rate brachytherapy (HDR) for locally advanced cervical cancer: A regional experience

Abstract

5162 Background: CRT with HDR has become standard practice for patients (pts) with locally advanced cervical cancer. However, the clinical outcome data remains sparse in patients treated with CRT-HDR compared to CRT-low dose rate brachytherapy (LDR). This is a report of Sacramento regional experience utilizing CRT-HDR over a 10-year period. Methods: 232 pts with locally advanced cervical carcinoma (FIGO Stage IB2/IIA: 15%, IIB: 53%, III: 28%, IVA: 3%) who were treated with concurrent chemotherapy (5FU ± CDDP every 4 weeks or CDDP weekly), external beam RT and HDR with a curative intent from 3/91 to 10/01 were analyzed retrospectively. 74 pts had lymph node (LN) involvement pathologically or radiographically, of whom 30 had positive paraaortic LN. 100 pts (43%) received an extended field RT. 175 pts completed treatment within 8 weeks. The survival analysis and the association of independent variables (e.g. age, stage, tumor size, LN status, treatment duration) with overall (OS) and disease-free survival (DFS) were performed using the Kaplan-Meier method and Cox proportional hazards model, respectively. Results: Median follow-up of 139 surviving pts was 4 years with 20 lost to follow-up within a year. The estimated 5-year OS and DFS rates for all pts were 58% and 63%. 21 pts had documented in-field failure and 57 had distant metastases. Advanced stage and LN involvement predicted for worse DFS (p<0.001, p<0.015 respectively). In a multivariate analysis, only the stage predicted for worse OS and DFS (p<0.015) and treatment duration predicted for worse OS (e.g. increase of 1 treatment day was associated with 1% increased hazard of death). Grade 3/4 late effects were observed in small bowel (6%), rectum (4%), and bladder (8%). Conclusions: Aggressive CRT integrating HDR is feasible in this high-risk population. The late effects were comparable to CRT-LDR data reported in RTOG 90–01. This experience included many patients ineligible for RTOG 90–01 due to worse prognoses (e.g., hydronephrosis/renal dysfunction, paraaortic LN involvement). Nevertheless, the OS and DFS were favorable. Comparison of survival data of our cohort to those of RTOG 90–01 will be presented. No significant financial relationships to disclose.