Grigsby PW, Portelance L, Williamson JF. High dose rate (HDR) cervical ring applicator to control bleeding from cervical carcinoma. Int J Gynecol Cancer 2002;12:18-21. The objective of this study was to evaluate the use of the high dose rate (HDR) cervical ring applicator to control acute cervical bleeding from carcinoma of the uterine cervix. This study consists of 15 patients presenting with invasive carcinoma of the uterine cervix with acute vaginal bleeding requiring transfusion. Initial irradiation, delivered emergently because of vaginal bleeding, consisted of two fractions (5 Gy each fraction to the surface of the cervix) utilizing the HDR intracavitary vaginal ring applicator. Two fractions were administered at one week intervals for a total of 10 Gy to the surface of the cervix. Irradiation doses from the HDR ring applications were not considered into the composite total dose to point A. Diagnostic imaging evaluation and initiation of external irradiation were commenced during this initial weekly interval between fractions. Vaginal bleeding requiring no additional transfusions was achieved in 93% (14/15) of patients. No acute or long-term Grades 3, 4, or 5 bowel or bladder sequelae were noted. In conclusion, HDR cervical ring brachytherapy is effective in controlling acute vaginal bleeding and can be delivered without undue acute or long-term toxicity.
76 ±4 Gy Vs 113±25 Gy & 86 ±14 Gy). D 90 did not correlate with point A dose (p = 0.78). Four percent of the patients (1/25) had acute Grade 3 GI toxicity; none had acute GU toxicity. A total of 4% of patients (1/25) had chronic Grade 3 GI toxicity; none had chronic GU toxicity. OS and DFS at 1 year were 100% and 94.4%. Four percent of the patients (1/25) failed locally and 4% failed distally (1/25). The patient who failed locally received 76 Gy to point A (adenocarcinoma histology). Conclusions: Image guided cervix BT has changed the paradigm for target definition and dose evaluation, but clinical practice of dose prescription itself remains varied as documented in practice patterns. As observed in this study, prescribing to point A may result in higher OAR doses and reduced target coverage. This data indicates that point A as a surrogate for target definition in an era of image guided brachytherapy might be unnecessary, and possibly detrimental.
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