Efficacy of 125I seeds implantation for pelvic recurrence of cervical cancer after radiotherapy

Abstract

Objective To evaluate the efficacy and adverse effects of 125I seeds implantation for pelvic recurrence of cervical cancer (PRCC) after radiotherapy. Methods From July 2005 to October 2015, 36 PRCC patients (median 44 years) after radiotherapy in Peking University Third Hospital were enrolled in this retrospective study. All patients underwent 125I seeds implantation under ultrasound or CT guidance. Treatment planning was performed before implantation to estimate the number and activity of 125I seeds. The seed numbers ranged from 10-140 (median: 62.5), and the activity ranged from 18.5-29.6(median: 25.9) MBq. Postoperatively, the median dose delivered to 90% gross tumor volume (D90) was 127.3 Gy. Kaplan-Meier method was used to calculate local progress free survival (LPFS) rate and overall survival (OS) rate, and log rank test and Cox regression were used for univariate and multivariate analyses. Results The median follow-up time was 11.5 months. The local control rate was 88.89%(32/36). The 1-year LPFS rate was 34.9% and the 1-year OS rate was 52.0%. Thirty-one patients died, of which 22 (70.97%, 22/31) died from cancer. Univariate analysis showed that the location of recurrence (χ2=5.195), volume of lesion (hazard ratio (HR)=1.012) and D90 (HR=0.988) were significantly correlated with LPFS (all P 0.05), respectively. Vaginal fistula, which may be caused by the treatment, occurred in 1 case. No other sever adverse effects were observed. Conclusions 125I seeds implantation is a safe and effective treatment for PRCC after radiotherapy. With the treatment of 125I seeds implantation, patients with pelvic wall recurrence may achieve better therapeutic effects than those with central recurrence. Key words: Uterine cervical neoplasms; Neoplasm recurrence, local; Brachytherapy; Iodine radioisotopes; Treatment outcome