title: High-dose rate brachytherapy using inverse planning simulated annealing for locoregionally advanced cervical cancer: a clinical report with 2-year follow-up.
abstract: OBJECTIVE
  We present clinical outcomes of image-guided brachytherapy using inverse planning simulated annealing (IPSA) planned high-dose rate (HDR) brachytherapy boost for locoregionally advanced cervical cancer.
  
  
  METHODS
  From February 2004 through December 2006, 51 patients were treated at the University of California, San Francisco with HDR brachytherapy boost as part of definitive radiation for International Federation of Gynecology and Obstetrics Stage IB1 to Stage IVA cervical cancer. Of the patients, 46 received concurrent chemotherapy, 43 with cisplatin alone and 3 with cisplatin/5-fluorouracil. All patients had IPSA-planned HDR brachytherapy boost after whole-pelvis external radiation to a total tumor dose of 85 Gy or greater (for alpha/beta = 10). Toxicities are reported according to National Cancer Institute CTCAE v3.0 (Common Terminology Criteria for Adverse Events version 3.0) guidelines.
  
  
  RESULTS
  At a median follow-up of 24.3 months, there were no toxicities of Grade 4 or greater and the frequencies of Grade 3 acute and late toxicities were 4% and 2%, respectively. The proportion of patients having Grade 1 or 2 gastrointestinal and genitourinary acute toxicities was 48% and 52%, respectively. Low-grade late toxicities included Grade 1 or 2 vaginal, gastrointestinal, and hormonal toxicities in 31%, 18%, and 4% of patients, respectively. During the follow-up period, local recurrence developed in 2 patients, regional recurrence developed in 2, and new distant metastases developed in 15. The rates of locoregional control of disease and overall survival at 24 months were 91% and 86%, respectively.
  
  
  CONCLUSIONS
  Definitive radiation by use of inverse planned HDR brachytherapy boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, CA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kim
authors.forename: Alice
authors.initials: A
authors.lastname: Wang-Chesebro
authors.forename: Vivian
authors.initials: V
authors.lastname: Weinberg
authors.forename: Jean
authors.initials: J
authors.lastname: Pouliot
authors.forename: Lee-May
authors.initials: LM
authors.lastname: Chen
authors.forename: Joycelyn
authors.initials: J
authors.lastname: Speight
authors.forename: Ramey
authors.initials: R
authors.lastname: Littell
authors.forename: I-Chow
authors.initials: IC
authors.lastname: Hsu
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000473:pathology; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014566:Urogenital System / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil