Radical radiotherapy with high‐dose‐rate brachytherapy for uterine cervix cancer long‐term results†

Abstract

The aim of this is to report the results of radical radiotherapy in carcinoma of the cervix treated by high-dose rate (HDR) intracavitary brachytherapy and external beam radiotherapy (XRT) at a single centre in Singapore. This is a retrospective analysis of 106 consecutive cases with histologically proven cervical cancer, treated by HDR brachytherapy and XRT at the Mount Elizabeth Hospital from 1990 to 1993. External beam radiotherapy to the pelvis was delivered with 6 MV photons, to 45-50.4 Gy in 1.8 Gy fractions. High-dose-rate brachytherapy comprised two to three applications of an intrauterine tandem with paired ovoids, to a median dose of 18 Gy to point 'A', carried out during XRT. All 106 patients completed treatment. Their ages ranged from 32 to 80 years (median 57 years). Most patients presented with stage II or III disease (44 and 37%, respectively) and with squamous cell carcinoma (91%). Median follow-up time was 59 months (range 2-169 months). The 5-year relapse-free survival rate across all stages was 71%. The corresponding overall survival rate was 69%. Local control was achieved in 86 patients (81%); six patients had residual disease (6%), and 14 patients had local recurrence (13%). Fourteen patients developed metastatic disease (13%). On univariate analysis, tumour stage, haemoglobin level, number of brachytherapy treatments and overall treatment time were found to be prognostic factors for overall survival. Late complications were mild (Radiation Therapy Oncology Group score 1-2), except for one patient with grade 4 rectal toxicity. The complication rates were 8, 14 and 45%, respectively, for the rectum, bladder and vagina (stenosis). The use of two to three fractions of HDR intracavitary brachytherapy in addition to pelvic XRT achieves good outcomes.

Comparison of iso-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer – regional cancer center experience

“…Khor et al ., in a retrospective analysis, presented long-term results of 106 cervical cancer cases treated with HDR brachytherapy in a single center in Singapore. They summarized that the use of fewer fractions of HDR brachytherapy (compared with the ABS recommendations) with whole-pelvis XRT, without compromising tumor control, has positive economic implications for less developed countries having high cervical cancer prevalence and limited RT resources [23].…”

A retrospective audit of treatment pathway for women diagnosed with cervical cancer in the Auckland region 2012–2016

“…It is difficult to conclude the exact reasons for this and is likely multifactorial related to an increased utilisation of brachytherapy and chemotherapy and improved MDM pathway. A study by Khor et al . carried out at a single centre in Singapore on 106 patients showed an OTT of 50 days (range of 31–65 days).…”

Management pathway for patients with cervical cancer in the Auckland region 2003-2007

“…In that study, the median external beam radiation therapy (EBRT) dose was 45 Gy, and median HDR brachytherapy dose was 18 Gy in three fractions. The relatively short OTT likely relates to the number and timing of the HDR brachytherapy insertions 22 . Two to three insertions were performed, all during the EBRT component.…”

“…The relatively short OTT likely relates to the number and timing of the HDR brachytherapy insertions. 22 Two to three insertions were performed, all during the EBRT component. The range of OTT was from 31 to 65 days, and even with these relatively short OTTs, a reduction in overall survival was shown with longer OTTs.…”