title: High-dose rate brachytherapy in the treatment of carcinoma of uterine cervix: twenty-year experience with cobalt after-loading system.
abstract: This retrospective analysis aims to report results of patients with cancer of uterine cervix treated with external-beam radiotherapy (EBR) and high-dose rate (HDR) brachytherapy, using manual treatment planning. From 1975 to 1995, 237 patients with FIGO stages IIB-IVA and mean age of 54.31 years were treated. EBR dose to the whole pelvis was 50 Gy in 25 fractions. Brachytherapy with HDR after-loading cobalt source (Cathetron) was performed following EBR completion with a dose of 30 Gy in three weekly fractions of 10 Gy to point A. Survival, local control, and genitourinary and gastrointestinal complications were assessed. In a median follow-up of 60.2 months, the 10-year overall and disease-free survival rate was 62.4%. Local recurrence was seen in 12.2% of patients. Distant metastases to the lymph nodes, peritoneum, lung, liver, and bone occurred in 25.3% of patients. Less than 6% of patients experienced severe genitourinary and/or gastrointestinal toxicity that were relieved by surgical intervention. No treatment-related mortality was seen. This series suggests that 50 Gy to the whole pelvis together with three fractions of 10 Gy to point A with HDR brachytherapy is an effective fractionation schedule in the treatment of locally advanced cancer of cervix. To decrease the complications, newer devices and treatment planning may be beneficial.
authors.affiliation: Radiation Oncology Department, Shiraz University of Medical Science, Nemazee Hospital, Shiraz, Iran. mosalaa@sums.ac.ir
authors.forename: A
authors.initials: A
authors.lastname: Mosalaei
authors.forename: M
authors.initials: M
authors.lastname: Mohammadianpanah
authors.forename: S
authors.initials: S
authors.lastname: Omidvari
authors.forename: N
authors.initials: N
authors.lastname: Ahmadloo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002277:Carcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D003037:Cobalt Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D052776:Female Urogenital Diseases / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D011832:Radiation Injuries / Q000453:epidemiology; D011879:Radiotherapy Dosage; D012006:Rectovaginal Fistula / Q000209:etiology; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary
chemical_list: D003037:Cobalt Radioisotopes