High-dose-rate versus low-dose-rate intracavitary therapy for carcinoma of the uterine cervix: a randomized trial

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

“…Our prospective study demonstrated good 2-year and 3-year PDPF rates of 96% (95% CI, 92%-100%) and an acceptable level of toxicity in 60 patients with nonbulky (<4-cm, assessed by MRI) stage I and II cervical cancer. These results suggest the clinical validity of previously reported results of other Japanese studies (4,7,8,28).…”

“…Several RCTs have demonstrated that high-dose-rate ICBT (HDR-ICBT) achieves rates of local control and late toxicity that are similar to those of low-dose-rate ICBT (LDR-ICBT) (7,8). Therefore, HDR-ICBT will likely replace LDR-ICBT as the standard of treatment, with several advantages over the LDR-ICBT.…”

“…Dosing schedules of HDR-ICBT (i.e., total dose and fractions in combination with EBRT) differ substantially among various countries, both in clinical practice (3,4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and in published guidelines (21,22). Table 1 lists various schedules for definitive RT with HDR-ICBT along with pelvic control rates for stage I and II cervical cancer (3,4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Immediately evident is the lack of a clear dose-response relationship between biologically effective dose (BED) at point A and pelvic control, which has been previously noted (23).…”

Long‐term results of high‐dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix

“…Several other HDR series utilized similar Point A doses (BED ϭ 46 -77 Gy 10 for early-stage disease, and 67-86 Gy 10 for advanced-stage disease), and they also achieved similar results. 7,10,12 In the large LDR series, the 5-year PC and OS rates were approximately 90% and 80%, respectively, for patients with Stage IB disease, 70 -80% and 60 -70%, respectively, for patients with Stage II disease, and 50 -70% and 30 -50%, respectively, for patients with Stage III disease. [22][23][24][25][26] The outcomes achieved in the current series therefore were comparable to those of the large LDR series.…”

“…However, to our knowledge there have been only a very few studies published to date in which disease status and late complications were monitored for Ͼ 10 years after treatment, although HDR-ICBT has been used extensively in Asia and Europe for Ͼ 3 decades. [3][4][5][7][8][9][10][11][12] Therefore, the safety of HDR treatment has not been investigated thoroughly.…”