Carcinoma of the uterine cervix: twice- versus once-weekly high-dose-rate brachytherapy.
OBJECTIVE
To compare the effectiveness and safety of once- versus twice-weekly high-dose-rate (HDR) brachytherapy for cervical cancer.


METHODS
From 1980 to 1997, 124 consecutive previously untreated patients with cervical cancer were treated with external-beam irradiation (50 Gy) and HDR brachytherapy. Clinical stages were I, 4 (3%) patients; II, 51 (41%); III, 64 (52%); and IV, 5 (4%). From 1980 to 1992, 74 patients (group A) were treated with HDR brachytherapy once weekly (about three fractions of 7 Gy each to point A [2 cm superior and 2 cm lateral to the inferior end of the intrauterine radioactive source]), while from 1992 to 1997, 50 patients (group B) were treated twice weekly (about six fractions of 4.5 Gy each to point A).


RESULTS
Overall survival rate at 5 years was 65.2% in group A and 65.3% in group B (P=.96). Local recurrence-free survival rate at 5 years was 69% (51 of 74 patients) in group A and 90% (45 of 50 patients) in group B (P<.001). The rate of grade 2 (moderate) and grade 3 (severe) complications was significantly lower in group B (6% vs. 32% in group A, P<.001). At multivariate analysis, the variables significantly associated with increased local-regional recurrence rates were having stage III-IV lesions (P=.04) and with fewer than six sessions of HDR brachytherapy (P=.02).


CONCLUSIONS
The twice-weekly HDR regimen may improve the local control rate with fewer complications.
Department of Radiology, Division of Radiation Oncology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan.
Y
Y
Hama
M
M
Uematsu
I
I
Nagata
A
A
Shioda
A
A
Suda
Y
Y
Sakurai
M
M
Kono
T
T
Tamura
S
S
Kusano
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011882:Radiotherapy, High-Energy; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*