High-dose-rate remote afterloading irradiation of carcinoma of the cervix in Hong Kong: unexpectedly high complication rate.
One hundred and thirty-six patients with biopsy-proven carcinoma of cervix were treated with external beam irradiation to the whole pelvis (46 Gy in 23 fractions) and three weekly applications of high-dose-rate (HDR) intracavitary brachytherapy of 7 or 8 Gy per fraction to point A (2 cm above and 2 cm lateral to the cervical os). The actuarial 5-year survival rate was 72% (Stage IB 85%; IIA 64%; IIB 70%; IIIA 25%; IIIB 53%). Patient age above 61 years and Stage III disease were adverse determinants for survival as shown by multivariate analysis. Late complications developed in 47% (65/137) of patients. Grade 3 or above complications occurred in the bladder, small bowel and sigmoid colon/rectum in 5%, 3% and 7% of patients, respectively. The most significant determinant of severe rectal complications was the addition of a lower vaginal tandem (P less than 0.01); the other determinants of rectal complications included a uterine length greater than 5 cm, a total biologically effective dose to the rectum of more than 120 Gy3 and Stage III disease.
Choi
P
P
Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital.
Teo
P
P
Foo
W
W
O
S K
SK
Leung
S F
SF
Tsao
S Y
SY
Shiu
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D002588:Cesium Radioisotopes / Q000627:therapeutic use; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D005260:Female; D006723:Hong Kong; D006801:Humans; D007420:Intestine, Large / Q000528:radiation effects; D007421:Intestine, Small / Q000528:radiation effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010388:Pelvis / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D015996:Survival Rate; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*
D002588:Cesium Radioisotopes; D003037:Cobalt Radioisotopes