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

Abstract

BACKGROUNDThe authors performed a long‐term follow‐up study to evaluate the efficacy and late toxicity of high‐dose rate intracavitary brachytherapy (HDR‐ICBT) for cervical carcinoma.METHODSFrom 1968 to 1986, 1148 patients with Stage IB to IVB squamous cell carcinoma of the cervix (staging was performed according to the International Federation of Gynecology and Obstetrics) were treated with a combination of external beam radiotherapy (EBRT) and HDR‐ICBT. For patients with early‐stage disease, 20 gray (Gy) of EBRT was delivered to the whole pelvis, followed by 24 Gy/4 fractions of HDR‐ICBT and 30 Gy of central‐shielding EBRT. For patients with advanced‐stage disease, 20–40 Gy of whole pelvic EBRT was administered, followed by 24 Gy/4 fractions of ICBT and 30–10 Gy of central‐shielding EBRT. The overall treatment time was approximately 6 weeks. Among survivors, the follow‐up rate was 98% and the median follow‐up duration was 22 years.RESULTSThe 10‐year pelvic tumor control rates were 93% for patients with Stage IB disease, 82% for patients with Stage II disease, and 75% for patients with Stage III disease. The 10‐year overall and cause‐specific survival rates were 74% and 89% for patients with Stage IB disease, 52% and 74% for patients with Stage II disease, and 42% and 59% for patients with Stage III disease, respectively. The 10‐year actuarial rates of major complications were 4.4% in the rectosigmoid colon, 0.9% in the bladder, and 3.3% in the small intestines.CONCLUSIONSThe results of the current study suggest that the combination of EBRT and HDR‐ICBT according to the authors' protocol provided outcomes that were comparable to those of the conventional low‐dose rate brachytherapy with acceptable rates of late complications in the treatment of cervical carcinoma. Cancer 2005. © 2004 American Cancer Society.

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).…”

“…Numerous retrospective studies of definitive radiotherapy (RT) have reported favorable local control with an acceptable level of toxicity for patients with early-stage cervical cancer (1)(2)(3)(4). A randomized clinical trial (RCT) performed in Italy in the 1990s revealed no significant difference in overall survival between patients treated with surgery and those treated with definitive RT (5).…”

“…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).…”

Increased expression of pAKT is associated with radiation resistance in cervical cancer

“…All of these patients were given external beam radiotherapy (EBRT) as well as high-dose rate (HDR) intracavitary brachytherapy (Lee et al, 2004;Nakano et al, 2005). The whole pelvis total dose was 5040 Gy with 1.8 Gy of daily fraction, administered five times a week.…”

High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible??

“…Even though there are more than four decades of published literature on the optimum dose fractionation schedules in HDR ICBT for the treatment of cervical cancer, there is still no uniform consensus on it [3,4]. The American Brachytherapy Society (ABS) has recommended an individual fraction size of \7.5 Gy in four to eight fractions, depending on the dose per fraction.…”