Abstract
To report the disease-free Grade ≥3 complication-free survival of a Phase II protocol of reirradiation with high-dose-rate (HDR) interstitial brachytherapy (ITB) in previously irradiated gynecologic cancer. Fifteen patients with previously irradiated cervical (n= 6), endometrial (n= 6), and vulvovaginal tumors (n= 3) were treated with HDR-ITB alone to a median dose of 38Gy in 8b.i.d. fractions over 4 consecutive days. Prior treatments included surgery (n= 12; 80%), external irradiation (n= 15; 100%), and brachytherapy (n= 9; 60%). Average clinical target volume Size was 60.9cc (range, 14.8-165.3 cc), and median time to reirradiation was 3.9years (range, 0.4-22.7 years). With a median followup of 2.8years (range, 1.2-9.2 years), 3 patients (20.0%) developed Grade ≥3 toxicity consisting of Grade 3 intestinal obstruction (n= 1), Grade 4 rectovesical fistula (n= 1), and Grade 5 intestinal obstruction (n= 1). Six patients remain alive and without evidence of disease at last followup. Two patients are alive with disease progression, and 7 patients have died, 4 of them from disease progression and 3 from other causes. The 2-year disease-free Grade ≥3 complication-free survival was 40%. HDR-ITB alone is a reasonable salvage treatment option in a significant number of patients with previously irradiated gynecologic tumors.
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