Phase II clinical trial using californium 252 fast neutron brachytherapy, external pelvic radiation, and extrafascial hysterectomy in the treatment of bulky, barrel-shaped stage IB cervical cancer

Abstract

From June 1977 to June 1983, 32 patients with bulky (greater than 4 cm diameter), barrel-shaped Stage IB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy using californium 252 (252Cf) and external pelvic radiation followed by extrafascial hysterectomy. Nineteen patients had cervical tumors 4 to 6 cm in diameter, and 13 patients had lesions in excess of 6 cm in diameter. A dose of 4500 rad external photon therapy was given from a linear accelerator, and one or two 6-hour 252Cf implants were given during or immediately after external radiation. Extrafascial hysterectomy with bilateral salpingo-oophorectomy was performed 6 weeks after completion of radiation therapy. Complications during and after radiation were minimal and included vaginal stenosis (three) and proctitis (two). Tumor clearance in the hysterectomy specimen was complete in 23 patients (72%) and residual cervical tumor was present in 9 patients (28%). Two patients developed tumor recurrence and died of disease 15 and 27 months after therapy, respectively. Thirty patients remain free of disease 26 to 96 months (median, 52 months) after treatment, and none have been lost to follow-up. The actuarial survival of these patients is 97% at 2 years and 94% at 5 years. Intracavitary neutron therapy is well tolerated and is effective when combined with external radiation and hysterectomy in the treatment of bulky, barrel-shaped Stage IB cervical cancer.

Combination of external beam radiotherapy and Californium (Cf)-252 neutron intracavity brachytherapy is more effective in control of cervical squamous cell carcinoma than that of cervical adenocarcinoma

“…Cf-252 neutron source also has higher RBE and lower oxygen enhancement rate against photon radio-resistance. Cf-252 neutron ICBT has been found effective for radiotherapy and possesses radiobiological advantages in treatment of radio-resistant, advanced, or bulky cervical cancer [17,31]. In this regard, our current data support the effect of Cf-252 neutron ICBT combined with external beam radiotherapy on cervical AC and SCC.…”

“…For example, a previous study reported by Maruyama and his associates [24] compared the effect of Cf-252 with Cs-173 ICBT combined with EBRT for stage III cervical cancer and showed 54 % 5-year OS rate with Cf-252 ICBT and 12 % with Cs-137 ICBT. After that, this group of physicians also conducted a phase II clinical trial [25] to compare the effectiveness of cf-252 ICBT and EBRT followed by extrafascial hysterectomy with Cs-137 ICBT on bulky and barrel-shaped stage IB cervical cancer. They found that 34 % (15/44) of patients were positive after Cs-137 and only one in 21 patients was positive after Cf-252 therapy.…”