title: Management of stage I-B, II-A, and II-B carcinoma of the cervix with high-dose-rate brachytherapy: initial results of an institutional clinical trial.
abstract: In 1989, the University of Miami began a program incorporating high-dose-rate (HDR) brachytherapy into the definitive treatment of patients with invasive carcinoma of the cervix. Patients received an average total dose to point A of 5,511 cGy (range 4,280-6,360 cGy) in an average of 57 days (range 39-84 days). An analysis of the first 24 cases found 11 FIGO Stage I-B, four Stage II-A, and nine Stage II-B tumors. At the end of all radiation therapy, 19/24 patients' tumors (79.2%) had undergone a clinical complete response (CR). With median follow-up of 26 months (range 14-63 months), three have relapsed locally, two regionally, and six in extrapelvic sites. Almost two-thirds of all failures occurred in patients with tumors >4 cm, who also took more than 8 weeks to complete their treatment. Overall 2-year actuarial survival for the entire study group is approximately 74%. A univariate analysis determined that clinical stage (P = 0.02), overall treatment time (P = 0.03), tumor size (P = 0.05), and response at the end of therapy (P = 0.005) were significant prognostic factors. Multivariate analysis showed that tumor response to therapy was the most important prognosticator of outcome (P = 0.001). Besides five cases of apical vaginal stenosis, there have been no reported chronic complications in this cohort of patients. A prospectively randomized trial is recommended to compare the efficacy of HDR vs. low-dose-rate brachytherapy in cervical carcinoma.
authors.affiliation: Department of Radiation Oncology, Baptist Hospital of Miami, FL 33176, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Abitbol
authors.forename: A H
authors.initials: AH
authors.lastname: Wolfson
authors.forename: A A
authors.initials: AA
authors.lastname: Lewin
authors.forename: P V
authors.initials: PV
authors.lastname: Houdek
authors.forename: K A
authors.initials: KA
authors.lastname: Laufer
authors.forename: A H
authors.initials: AH
authors.lastname: Brandon
authors.forename: J Y
authors.initials: JY
authors.lastname: Ting
authors.forename: W A
authors.initials: WA
authors.lastname: Raub
authors.forename: H E
authors.initials: HE
authors.lastname: Averette
authors.forename: B U
authors.initials: BU
authors.lastname: Sevin
authors.forename: A M
authors.initials: AM
authors.lastname: Markoe
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*