title: A comparison of manual and remote afterloading in the treatment of carcinoma of the cervix: increasing dose rate with a flexible applicator.
abstract: A historical cohort design was used to assess the effect of introducing a remote afterloading system with a flexible applicator for the intracavitary treatment of cervical cancer. One hundred and sixty-eight patients treated for the 5 years prior to its introduction were compared to 84 patients treated for the first 3 years of its use. Patients were comparable with respect to age and stage. Treatment policies and techniques remained the same during the study period. Average dose rate to point A increased from 0.46 Gy/hr to 0.67 Gy/hr. The 3-year actuarial survival was equivalent between the two treatment modalities: 67.7% (manual), and 60.6% (remote). Patterns of local recurrence and distant failure were also equivalent between the two groups. Severe complication rates were comparable (8.3% manual, 6.3% remote) despite the increase in dose rate, confirming that the remote afterloading system can be safely adapted to a flexible applicator. The introduction of the remote afterloading system resulted in a 72% reduction in radiation exposure to staff.
authors.affiliation: Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: T J
authors.initials: TJ
authors.lastname: Whelan
authors.forename: J E
authors.initials: JE
authors.lastname: Aldrich
authors.forename: S M
authors.initials: SM
authors.lastname: Voruganti
authors.forename: O S
authors.initials: OS
authors.lastname: Wong
authors.forename: J F
authors.initials: JF
authors.lastname: Filbee
authors.forename: P J
authors.initials: PJ
authors.lastname: Joseph
authors.forename: J F
authors.initials: JF
authors.lastname: Jeffrey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*