Vaginal applicators (ovoids) for local control and alleviation of rectal complications of cervical cancers treated by brachytherapy.
OBJECTIVE
To assess the effects of vaginal applicators (ovoids) on dose distribution, local control and rectal complications in cervical cancers treated by brachytherapy.


METHODS
From 1984 to 1992, 41 patients (15 stages I+II; 26 stages III+IV) were treated by high-dose-rate brachytherapy (20 Gy in 4 fractions) after external beam irradiation (36-56 Gy). Twenty-three patients were treated by standard application of both intrauterine tandem and ovoids, and 18 patients were treated by non-standard application.


RESULTS
The five-year, local-relapse-free rates by standard application and tandem alone were 69 and 65% overall; 83 and 100% for stages I+II; and 62 and 49% for stages III+IV. Local control was related to tumor response following the external beam irradiation and initial tumor size by multivariate analysis. Rectal complications seen in patients followed for more than 1 year were 33% after standard application and 22% for tandem use alone. The rectal doses given for standard application (24 Gy) and tandem use (16 Gy) were significantly different.


CONCLUSIONS
The ovoid sources did not always contribute to local control, and occasionally led to rectal complications. The optimization of brachytherapy was dependent on patients' anatomy, tumor size, and tumor response.
Ohizumi
Y
Y
Department of Radiation Oncology, Tokai University School of Medicine, Kanagawa, Japan. oizumi@is.icc.u-tokai.ac.jp
Akiba
T
T
Imamiya
S
S
Tamai
Y
Y
Mori
T
T
Shinozuka
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011829:Radiation Dosage; D012002:Rectal Diseases / Q000209:etiology / Q000517:prevention & control*; D017741:Survivors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000532:radiotherapy*; D014621:Vagina