Interstitial High Dose Rate (HDR) Brachytherapy with Open Laparotomy for Locally Advanced Primary or Recurrent Gynaecological Cancer: Peter MacCallum Cancer Centre Experience

Abstract

To report the technique and treatment outcomes of open interstitial brachytherapy performed at the Peter MacCallum Cancer Centre between 2007- 2013. Between June 2007 and December 2013, 11 patients were treated with curative intent using open interstitial implants as a radiotherapy boost (in combination with external beam radiotherapy (EBRT) and weekly platinum chemotherapy. Patients had no evidence of nodal or distant metastasis, and were receiving either upfront treatment for carcinoma of the vagina (n=2) or cervix stump (n=1) or isolated vault recurrence following primary surgery (cervix- 4; endometrium - 3; vagina-1). The main rationale for laparotomy was to minimise toxicity to bowel by allowing 1) placement of a spacer between interstitial needles and the bowel 2) adhesion lysis, if required 3) direct visualization of needle placement. RT planning was performed using MRI and CT. With a minimum follow up of 2 years, 10 of 11 patients were alive and 6 patients were disease-free and remained asymptomatic. These patients were either receiving primary treatment or had a prolonged disease-free interval between their initial primary treatment and presentation with recurrent disease. Of the remaining 5 patients, all had either persistent disease or relapsed at primary site. 1 of them developed distant metastasis and died of disease. 2 of these patients progressed in the inguinal nodes. 4 patients were alive with disease at 12 months, 3.5 years, 3 years and 2 years from the date of implant. Open Interstitial Implant is feasible and tolerated with acceptable toxicity. However, patient selection and adequate expertise are of utmost importance.