Outcomes of high-dose-rate interstitial brachytherapy in the treatment of locally advanced cervical cancer: long-term results

Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):714-20. doi: 10.1016/j.ijrobp.2012.05.033. Epub 2012 Jul 3.

Abstract

Purpose: 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.

Methods and materials: 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.

Results: 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.

Conclusions: 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy / adverse effects
  • Brachytherapy / methods*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / radiotherapy*
  • Disease-Free Survival
  • Female
  • Humans
  • Hydronephrosis / diagnostic imaging
  • Hyperthermia, Induced / methods
  • Middle Aged
  • Neoplasm Staging
  • Proportional Hazards Models
  • Radiography
  • Radiotherapy / methods
  • Radiotherapy Dosage
  • Treatment Outcome
  • Tumor Burden
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / radiotherapy*
  • Young Adult