title: High-dose-rate intracavitary brachytherapy (HDR-IC) in treatment of cervical carcinoma: 5-year results and implication of increased low-grade rectal complication on initiation of an HDR-IC fractionation scheme.
abstract: OBJECTIVE
  To report the treatment results and rectal/bladder complications of cervical carcinoma radically treated with high-dose-rate intracavitary brachytherapy (HDR-IC). The current policy of using three-fraction scheme was examined.
  
  
  METHODS
  Between November 1987 and August 1990, 173 patients with cervical carcinoma were treated with curative-intent radiation therapy. Whole pelvic irradiation was administered with 10-MV X ray. Dose to the central cervix was 40-44 Gy in 20-22 fractions, following by pelvic wall boost 6-14 Gy in three to seven fractions with central shielding. 60Co sources were used for HDR-IC, and 7.2 Gy was given to Point A for three applications, 1-2 weeks apart. Duration of follow-up was 5-7.8 years.
  
  
  RESULTS
  Twenty-eight patients (16%) developed central-regional recurrences. Overall 5-year actuarial pelvic control rate was 83%. By stage, 5-year actuarial pelvic control rates were 94%, 87%, and 72% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Thirty-one patients (18%) developed distant metastasis. Overall 5-year actuarial survival rate was 58%. By stage, 5-year actuarial survival rates were 79%, 59%, and 41% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Sixty-six (38%) and 19 patients (11%) developed rectal and bladder complications, respectively. For rectal complication, the overall actuarial rate was 38% at 5 years. By grade, 5-year actuarial rectal complication rates were 24%, 15%, 4%, and 3% for Grades 1-4, respectively. Overall prevalence of rectal complications was 37% and 14% at 2 and 5 years, respectively. Prevalence of low-grade rectal complication (Grades 1 and 2) was dominant at 2 years (30%), but declined to 8% at 5 years. Prevalence of high-grade, severe rectal complication (Grades 3 and 4) remained steady at 2 and 5 years (7% and 6%, respectively). Five-year actuarial bladder complication was 9%. Five-year prevalence of bladder complication was 2%.
  
  
  CONCLUSIONS
  Using a three-fraction scheme, survival rate appeared comparable with the existing results of the low-dose-rate technique. The incidence of rectal complication with this scheme remained relatively high. The increased part of rectal complication was predominantly low grade. This result suggested that therapeutic gain with this scheme may not be good enough to circumvent its biologic disadvantage. Numbers of fractions >3 must be considered in future trials.
authors.affiliation: Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan.
authors.forename: C J
authors.initials: CJ
authors.lastname: Wang
authors.forename: S W
authors.initials: SW
authors.lastname: Leung
authors.forename: H C
authors.initials: HC
authors.lastname: Chen
authors.forename: L M
authors.initials: LM
authors.lastname: Sun
authors.forename: F M
authors.initials: FM
authors.lastname: Fang
authors.forename: C C
authors.initials: CC
authors.lastname: Changchien
authors.forename: E Y
authors.initials: EY
authors.lastname: Huang
authors.forename: J M
authors.initials: JM
authors.lastname: Wu
authors.forename: C C
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012007:Rectum / Q000528:radiation effects*; D015996:Survival Rate; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*