title: Clinical results of medium dose rate brachytherapy combined with external beam radiotherapy in the treatment of advanced cervical carcinoma.
abstract: OBJECTIVE
  To evaluate the overall and disease-free survival of patients with advanced cervical carcinoma (FIGO stages IIB-IIIB) treated with external beam radiotherapy (EBRT) and medium dose rate brachytherapy (MDR-BT) plus/minus surgery.
  
  
  METHODS
  One hundred and seven patients received preoperative RT (group A) and 154 were treated with definitive RT (group B); 73 patients in both groups also received cisplatin as radiosensitizer. EBRT delivered as preoperative reached a total dose of 44-46 Gy/pelvis, whereas the definitive RT reached a total dose of 62-64 Gy with standard fractionation. MDR-BT was performed with a LDR/MDR Cs-137 Selectron machine; 10 Gy/point A were delivered in the preoperative group A and 14 Gy/point A/, 1-2 fractions in group B. Cisplatin as radiosensitizer was administered during EBRT at a dose of 20 mg/m(2)/day for 5 days with 21 days interval between cycles.
  
  
  RESULTS
  With a median follow-up of 44.4 months (range 3.4-61.6) the overall survival at 3 years in group A was 92% vs. 68% for group B (p<0.01). According to FIGO stages 3-year overall survival was 88% in stage IIB, 79% in IIIA and 60% in IIIB (p<0.01). Three-year local control was 73.5% (192 patients). Thirty-three (13%) patients developed locoregional recurrences, and another 8 (3.07%) locoregional recurrences plus distant metastases.
  
  
  CONCLUSIONS
  The association of EBRT with MDR-BT represents an effective treatment in advanced cervical carcinoma. A significant difference in 3-year overall survival was found, favoring preoperative RT, with a very good rate of local control.
authors.affiliation: Department of Brachytherapy, Oncological Institute I. Chiricuta, Cluj-Napoca, Romania. claudia_ordeanu@yahoo.com
authors.forename: C
authors.initials: C
authors.lastname: Ordeanu
authors.forename: O
authors.initials: O
authors.lastname: Coza
authors.forename: S
authors.initials: S
authors.lastname: Gavris
authors.forename: N
authors.initials: N
authors.lastname: Todor
authors.forename: E
authors.initials: E
authors.lastname: Szilagy
authors.forename: M
authors.initials: M
authors.lastname: Bako
authors.forename: V
authors.initials: V
authors.lastname: Cernea
authors.forename: N
authors.initials: N
authors.lastname: Ghilezan
authors.forename: V
authors.initials: V
authors.lastname: Nagy
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*