Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma.
OBJECTIVE
Intracavitary brachytherapy plays an important role in the treatment of cervical carcinoma. Previous results have shown controversy between the effect of dose rate on tumor control and the occurrence of complications. We performed a prospective randomized clinical trial to compare the clinical outcomes between low-dose-rate (LDR) and high-dose-rate (HDR) intracavitary brachytherapy for treatment of invasive uterine cervical carcinoma.


METHODS
A total of 237 patients with previously untreated invasive carcinoma of the uterine cervix treated at King Chulalongkorn Memorial Hospital were randomized between June 1995 and December 2001. Excluding ineligible, incomplete treatment, and incomplete data patients, 109 and 112 patients were in the LDR and HDR groups, respectively. All patients were treated with external beam radiotherapy and LDR or HDR intracavitary brachytherapy using the Chulalongkorn treatment schedule.


RESULTS
The median follow-up for the LDR and HDR groups was 40.2 and 37.2 months, respectively. The actuarial 3-year overall and relapse-free survival rate for all patients was 69.6% and 70%, respectively. The 3-year overall survival rate in the LDR and HDR groups was 70.9% and 68.4% (p = 0.75) and the 3-year pelvic control rate was 89.1% and 86.4% (p = 0.51), respectively. The 3-year relapse-free survival rate in both groups was 69.9% (p = 0.35). Most recurrences were distant metastases, especially in Stage IIB and IIIB patients. Grade 3 and 4 complications were found in 2.8% and 7.1% of the LDR and HDR groups (p = 0.23).


CONCLUSIONS
Comparable outcomes were demonstrated between LDR and HDR intracavitary brachytherapy. Concerning patient convenience, the lower number of medical personnel needed, and decreased radiation to health care workers, HDR intracavitary brachytherapy is an alternative to conventional LDR brachytherapy. The high number of distant failure suggests that other modalities such as systemic concurrent or adjuvant chemotherapy might lower this high recurrence, especially in Stage IIB and IIIB.
Division of Radiation Therapy, Department of Radiology, Chulalongkorn University Faculty of Medicine, Bangkok 10330, Thailand. Prasert@chulacancer.net
Prasert
P
Lertsanguansinchai
Chawalit
C
Lertbutsayanukul
Kanjana
K
Shotelersuk
Chonlakiet
C
Khorprasert
Prayuth
P
Rojpornpradit
Taywin
T
Chottetanaprasith
Apiradee
A
Srisuthep
Sivalee
S
Suriyapee
Chotika
C
Jumpangern
Damrong
D
Tresukosol
Chulee
C
Charoonsantikul
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002588:Cesium Radioisotopes / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000528:radiation effects; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D015996:Survival Rate; D017211:Treatment Failure; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*
D002588:Cesium Radioisotopes; D007496:Iridium Radioisotopes