Abstract
The purpose of this study was to determine locoregional control (LRC), disease-free survival (DFS), and toxicity of high-dose-rate interstitial brachytherapy (HDR-ISBT) in the treatment of locally advanced cervical cancer. Between March 1996 and May 2009, 116 patients with cervical cancer were treated. Of these, 106 (91%) patients had advanced disease (International Federation of Gynecology and Obstetrics stage IIB-IVA). Ten patients had stage IB, 48 had stage II, 51 had stage III, and 7 had stage IVA disease. All patients were treated with a combination of external beam radiation therapy (EBRT) to the pelvis (5040 cGy) and 2 applications of HDR-ISBT to a dose of 3600 cGy to the implanted volume. Sixty-one percent of patients also received interstitial hyperthermia, and 94 (81%) patients received chemotherapy. Clinical LRC was achieved in 99 (85.3%) patients. Three-year DFS rates were 59%, 67%, 71%, and 57% for patients with stage IB, II, III, and IVA disease, respectively. The 5-year DFS and overall survival rates for the entire group were 60% and 44%, respectively. Acute and late toxicities were within acceptable limits. Locally advanced cervical cancer patients for whom intracavitary BT is unsuitable can achieve excellent LRC and OS with a combination of EBRT and HDR-ISBT.
Highlights
Conventional intracavitary brachytherapy (ICBT) may not deliver adequate doses in cases of advanced cervical disease or in patients with distorted anatomy
This was a single-institution study conducted at Long Beach Memorial Medical Center (LBMMC) institutional review board approval was obtained for this study, which analyzed the records of 116 of 121 consecutively treated patients (5 stage IVB patients were excluded) from March 1996-May 2009, with histologically proven cervical cancer, who completed at least 1 treatment of HDR-Interstitial BT (ISBT)
All patients were staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system [15]
Summary
Conventional intracavitary brachytherapy (ICBT) may not deliver adequate doses in cases of advanced cervical disease or in patients with distorted anatomy. Such cases are associated with a high incidence of local failure and complications [1, 2]. We reported results with low-dose-rate (LDR) ISBT in the treatment of patients with bulky cervical cancer [5]. Modern high-dose-rate (HDR) BT treatment planning systems offer radiation safety advantages as well as a fast and efficient source and dwell time optimized planning not possible with the older LDR-ICBT or ISBT treatment planning systems. In addition to practically no radiation exposure to visitors and staff, HDR ISBT results in overall shorter hospitalizations of 1 night compared to 3 days for LDR BT
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