title: High-dose-rate afterloading brachytherapy, external radiation therapy, and combination chemotherapy in poor-prognosis cancer of the cervix.
abstract: Fourteen patients with poor-prognosis cervical cancer were treated with concurrent chemotherapy (cisplatin and mitomycin-C), external radiation therapy (RT), and high-dose-rate (HDR) brachytherapy. Pelvic RT was delivered as (a) external-beam radiation (four-field box technique, 40.0 Gy), (b) brachytherapy using HDR 60Co or 192Ir (3.80 Gy/fraction, thrice weekly; total dose, 46.83 Gy) with intrauterine stent, and (c) parametrial boost using an AP field with custom-fabricated step wedges. Post-radical-hysterectomy patients received 50.40 Gy external RT and 3.23 Gy/day vaginal cylinder HDR at 1/2-cm depth (total dose, 16.15 Gy). Complete clinical and radiographic response was noted in all evaluable patients who are alive with no evidence of disease, 3 to 27 months after completion of therapy (median, 9 months). Toxicity consisted of grade 2 to 3 hematologic toxicity (4 patients) and nausea and vomiting in all, but grade 3 in only 2 patients. One patient had grade 2 diarrhea. The only major complication (small bowel obstruction) occurred in a patient with lupus vasculitis. This pilot study demonstrates the feasibility of this regimen in an outpatient setting with acceptable toxicity. More prolonged follow-up of our patients is required to determine its impact on long-term survival.
authors.affiliation: Division of Gynecologic Oncology, Wayne State University School of Medicine, Detroit, Michigan 48201.
authors.forename: V K
authors.initials: VK
authors.lastname: Malviya
authors.forename: I
authors.initials: I
authors.lastname: Han
authors.forename: G
authors.initials: G
authors.lastname: Deppe
authors.forename: J M
authors.initials: JM
authors.lastname: Malone
authors.forename: C W
authors.initials: CW
authors.lastname: Christensen
authors.forename: Y
authors.initials: Y
authors.lastname: Kim
authors.forename: K
authors.initials: K
authors.lastname: Ahmad
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects; D010865:Pilot Projects; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000628:therapy*