Purpose: Treatment of post-operative pelvic side-wall relapses of cervical cancer has always been a therapeutic challenge for radiation oncologists. Radiation dose boost to recurrent tumor by brachytherapy is necessary, but difficult to achieve. Our treatment center has successfully achieved precise transvaginal insertion of a pelvic side-wall mass, using a metal tube with real-time ultrasound guidance. This study investigates the efficacy and safety of image-guided high-dose-rate (HDR) interstitial brachytherapy (IBT) for patients with post-operative pelvic side-wall relapses.Material and methods: Between 2018 and 2020, 36 post-operative pelvic side-wall relapses of cervical cancer patients receiving external beam radiotherapy (EBRT) combined with HDR-IBT were analyzed retrospectively. Doses per fraction ranged from 6.0 to 7.0 Gy, whereas cumulative equivalent doses in 2 Gy fractions ranged from 80 to 100 Gy. Effects of prognostic factors on local control (LC) and progression-free survival (PFS) were analyzed, and late toxicity data were evaluated.Results: A total of thirty-six patients were included, with a median follow-up of 19.3 months. The tumor response was obtained for all patients, with radiological complete remission in 20 (55.6%) patients. Two-years LC and PFS rates were 72.2% and 47.2%, respectively. Grade II rectal toxicity was observed in 5 patients (13.9%). Multivariate analyses for LC and PFS using proportional regression model were performed, in which shape of exophytic tumor was associated with a significantly better prognosis for both LC and PFS (HR = 0.071, 0.128, p = 0.005, 0.002). Clinical target volume (CTV) D 90 remained associated with a significantly better prognosis for PFS (HR = 0.056, p = 0.000).Conclusions: A metal tube placed in the vagina, under the guidance of real-time ultrasound in transvaginal IBT for pelvis masses can be accurately achieved. The shape of exophytic tumor and CTV D 90 were associated with a significantly better prognosis for PFS, and the shape of exophytic tumor was also associated with a better prognosis for LC. Therefore, radiation dose boost using IBT can improve the prognosis of patients with post-operative pelvic side-wall recurrences of cervical cancer.

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Cervical small cell carcinoma (SCC) is a rare disease, with a high degree of malignancy and a poor prognosis. Para-aortic lymph nodes (PALN) are frequent sites of recurrence after pelvic chemoradiotherapy. In the present study, we report the case of a 26-year-old female patient with cervical SCC who suffered for two times PALN relapses. Our research results have shown that PALN lesions can be effectively controlled with permanent radiation therapy. Prophylactic PALN radiotherapy may be an effective option for patients with cervical SCC who require radical pelvic radiation therapy.