title: The quality of cervical cancer brachytherapy implantation and the impact on local recurrence and disease-free survival in radiation therapy oncology group prospective trials 0116 and 0128.
abstract: OBJECTIVE
  The objective of the study was to determine the impact of brachytherapy implant quality on outcome among cervical cancer patients treated on Radiation Therapy Oncology Group prospective trials 0116 and 0128.
  
  
  METHODS
  All enrolled patients received concurrent chemoradiation followed by brachytherapy. Individual brachytherapy parameters, including the symmetry of ovoids in relation to the tandem, displacement of ovoids in relation to the cervical os, tandem bisecting the ovoids, tandem in the midpelvis, and appropriateness of packing, were scored for each implant. Multivariate Cox proportional hazards models were constructed for each parameter for local recurrence (LR), regional recurrence, distant recurrence, disease-free survival (DFS), and overall survival.
  
  
  RESULTS
  Records for 103 patients were analyzed. The median follow-up time was 24.5 months. Patients with unacceptable symmetry of ovoids to the tandem had a significantly higher risk of LR than patients in the acceptable group (hazard ratio [HR], 2.67; 95% confidence interval [CI], 1.11-6.45; P = 0.03). Patients with displacement of ovoids in relation to the cervical os had a significantly increased risk of LR (HR, 2.50; 95% CI, 1.05-5.93; P = 0.04) and a lower DFS rate (HR, 2.28; 95% CI, 1.18-4.41; P = 0.01). Inappropriate placement of packing resulted in a lower DFS rate (HR, 2.06; 95% CI, 1.08-3.92; P = 0.03).
  
  
  CONCLUSIONS
  Assessment of the quality of a brachytherapy implant is imperative, as proper placement has an impact on patient DFS. If feasible, inappropriate placements should be corrected before treatment initiation. Brachytherapy applicators for cervical cancer should preferably be placed and assessed by experienced practitioners.
authors.affiliation: Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. aviswanathan@lroc.harvard.edu
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moughan
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.forename: Charles
authors.initials: C
authors.lastname: Levenback
authors.forename: Revathy
authors.initials: R
authors.lastname: Iyer
authors.forename: Sharon
authors.initials: S
authors.lastname: Hymes
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
authors.forename: Brigitte
authors.initials: B
authors.lastname: Miller
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000295:instrumentation / Q000592:standards*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*