Long-term results of low-dose-rate interstitial-intracavitary brachytherapy in the treatment of carcinoma of the cervix.
OBJECTIVE
Brachytherapy plays a major role in the treatment of patients with carcinoma of the cervix. However, routine intracavitary brachytherapy may not be feasible or adequate to treat locally advanced disease. The purpose of this retrospective study (spanning a 20-year period) was to determine the outcome of interstitial low-dose-rate brachytherapy in the treatment of bulky or locally advanced cervical cancer. The long-term survival and safety of this technique were evaluated, along with its impact on local and locoregional control, disease-free survival, and complications.


METHODS
A total of 185 previously untreated patients with cervical cancer were treated between 1977 and 1997. According to the International Federation of Gynecology and Obstetrics classification, 21 patients had Stage IB (barrel), 77 Stage II, 77 Stage III, and 10 Stage IV disease. All patients were treated by a combination of external megavoltage irradiation to the pelvis to a dose of 5040 cGy followed by interstitial-intracavitary implants to a dose of 40-50 Gy to the implanted volume in two applications.


RESULTS
Clinical local control was achieved in 152 (82%) of the 185 patients. A 5-year disease-free survival rate of 65%, 67%, 49%, and 17% was achieved for patients with Stage IB, II, III, and IV disease, respectively. Eighteen (10%) of the 185 patients developed Radiation Therapy Oncology Group Grade 3 or 4 late complications.


CONCLUSIONS
Patients with locally advanced cervical cancer, or with distorted anatomy, may be treated adequately with interstitial brachytherapy to achieve excellent locoregional control and a reasonable chance of cure with acceptable morbidity.
Department of Radiation Oncology, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90806, USA. nsyed@memorialcare.org
A M Nisar
AM
Syed
Ajmel A
AA
Puthawala
Nashwa Nazmy
NN
Abdelaziz
Mervat
M
el-Naggar
Philip
P
Disaia
Michael
M
Berman
Krishnansu S
KS
Tewari
Anil
A
Sharma
Adina
A
Londrc
Supriya
S
Juwadi
Joel M
JM
Cherlow
Steven
S
Damore
Yi-Jen
YJ
Chen
D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*