title: A feasibility study of 252Cf neutron brachytherapy, cisplatin + 5-FU chemo-adjuvant and accelerated hyperfractionated radiotherapy for advanced cervical cancer.
abstract: OBJECTIVE
  To evaluate the feasibility and toxicity of 252Cf neutron brachytherapy combined with hyperaccelerated chemoradiotherapy for Stage III and IV cervical cancers.
  
  
  METHODS
  Eleven patients with advanced Stage IIIB-IVA cervical cancers were treated with 252Cf neutron brachytherapy in an up-front schedule followed by cisplatin (CDDP; 50 mg/m2) chemotherapy and hyperfractionated accelerated (1.2 Gy bid) radiotherapy given concurrently with intravenous infusion of 5-Fluorouracil (5-FU) (1000 mg/m2/day x 4 days) in weeks 1 and 4 with conventional radiation (weeks 2, 3, 5, and 6). Total dose at a paracervical point A isodose surface was 80-85 Gy-eq by external and intracavitary therapy and 60 Gy at the pelvic sidewalls.
  
  
  RESULTS
  Patients tolerated the protocol well. There was 91% compliance with the chemotherapy and full compliance with the 252Cf brachytherapy and the external beam radiotherapy. There were no problems with acute chemo or radiation toxicity. One patient developed a rectovaginal fistula (Grade 3-4 RTOG criteria) but no other patients developed significant late cystitis, proctitis or enteritis. There was complete response (CR) observed in all cases. With mean follow-up to 26 months, local control has been achieved with 90% actuarial 3-year survival with no evidence of disease (NED).
  
  
  CONCLUSIONS
  252Cf neutrons can be combined with cisplatin and 5-FU infusion chemotherapy plus hyperaccelerated chemoradiotherapy without unusual side effects or toxicity and with a high local response and tumor control rate. Further study of 252Cf neutron-chemoradiotherapy for advanced and bulky cervical cancer are indicated. We found chemotherapy was more effective with the improved local tumor control.
authors.affiliation: Gershenson Radiation Oncology Center, Wayne State University, Detroit, MI 48201.
authors.forename: Y
authors.initials: Y
authors.lastname: Maruyama
authors.forename: M G
authors.initials: MG
authors.lastname: Bowen
authors.forename: J R
authors.initials: JR
authors.lastname: Van Nagell
authors.forename: H H
authors.initials: HH
authors.lastname: Gallion
authors.forename: P
authors.initials: P
authors.lastname: DePriest
authors.forename: J
authors.initials: J
authors.lastname: Wierzbicki
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D002142:Californium / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D009502:Neutrons / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000628:therapy*
chemical_list: D002142:Californium; D002945:Cisplatin; D005472:Fluorouracil