Efficacy and toxicity of concomitant cisplatin with external beam pelvic radiotherapy and two high-dose-rate brachytherapy insertions for the treatment of locally advanced cervical cancer.
OBJECTIVE
There is no standard high-dose-rate (HDR) brachytherapy dose for locally advanced cervical cancer. The objective of this study was to determine the efficacy, toxicity and clinicopathologic predictive markers affecting survival using cisplatin (CDDP) concomitant with external beam pelvic radiotherapy (EBRT) and two 9-Gy HDR insertions for the treatment of locally advanced cervical cancer.


METHODS
77 consecutive patients with Stage IB2-IV cervical cancer treated with CDDP, EBRT and two 9-Gy HDR insertions were included. Kaplan-Meier methods and Cox proportional hazards models were applied for survival statistics.


RESULTS
Median age was 53. 90% had squamous cell carcinoma. Median follow-up time was 3.5 years (range 0.5-12 years). Overall 5-year progression-free survival (PFS) was 75%. Local control rate and 5-year PFS were 88% and 83%, respectively, for Stages IB2/II, and 68% and 61%, respectively, for Stages III/IV. Grade 3/4 GI symptoms were the most common acute side effects (47%). Grade 3/4 late toxicities occurred in five (6%) patients.


CONCLUSIONS
HDR brachytherapy regimens consisting of two 9-Gy HDR insertions have similar efficacy and side effect profiles as other brachytherapy regimens for the treatment of cervical cancer with improved safety and patient convenience.
Novetsky
Akiva P
AP
Albert Einstein College of Medicine, Bronx, NY, USA.
Einstein
Mark H
MH
Goldberg
Gary L
GL
Hailpern
Susan M
SM
Landau
Evan
E
Fields
Abbie L
AL
Mutyala
Subhakar
S
Kalnicki
Shalom
S
Garg
Madhur
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
D000970:Antineoplastic Agents; D002945:Cisplatin