Does the entire uterus need to be treated in cancer of the cervix? Role of adaptive brachytherapy.
OBJECTIVE
To evaluate local control and toxicity by use of a method of adaptive cervical brachytherapy (ACB).


METHODS
From 1998 to 2008, we identified 65 cervical cancer patients with FIGO (International Federation of Gynecology and Obstetrics) Stage IB1-IVA disease who received definitive external beam radiation therapy and high-dose rate brachytherapy with tandem and ovoid applicators. As tumors regressed, 45 of 65 patients had the tandem source retracted from the uterine fundus at successive brachytherapy insertions, thus decreasing the number of (192)Ir dwell positions. Tests of trend and Fisher's exact test were used to identify the effect of ACB on disease control and toxicity. Kaplan-Meier analyses were performed to evaluate disease control and late complications.


RESULTS
The median follow-up was 24.5 months. Of the patients, 92% received chemotherapy. The 3-year overall survival, 3-year disease-free survival, 3-year distant metastasis-free survival, and local control rates were 67%, 76%, 79%, and 97%, respectively. There was only 1 isolated local failure, and there were no local failures beyond 1 year. Distant failure was involved in 93% of recurrences. No significant trend was identified regarding the extent of retraction of the tandem source start position with either failure or toxicity. Acute and actuarial 3-year late Grade 3 toxicity or greater occurred in 24.6% and 17% of patients, respectively.


CONCLUSIONS
ACB determined by clinical response yielded excellent local control rates. These data indicate that ACB may be useful in decreasing late toxicities from high-dose rate brachytherapy. With the advent of three-dimensional image-guided brachytherapy, additional methods to adapt treatment technique to changes in tumor volume warrant investigation.
Anker
Christopher J
CJ
Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT 84112-5560, USA.
Cachoeira
Charles V
CV
Boucher
Kenneth M
KM
Rankin
Jim
J
Gaffney
David K
DK
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D012007:Rectum / Q000528:radiation effects; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D014594:Uterine Neoplasms / Q000532:radiotherapy; D014621:Vagina / Q000528:radiation effects
D007496:Iridium Radioisotopes