title: High-dose-rate interstitial computed tomography-based brachytherapy for the treatment of cervical cancer: early results.
abstract: OBJECTIVE
  There is limited published data on high-dose-rate interstitial brachytherapy (HDRBT) for cervical cancer resulting in no consensus on a fractionation schedule. This study reports our experience of CT-based HDRBT for treating locally advanced cervical cancer.
  
  
  METHODS
  Forty-seven patients diagnosed with Stage IIB-IVA cervical cancer not suitable for intracavitary brachytherapy were treated with HDRBT from March 2005 to November 2010. All patients received external beam radiation therapy with a median dose of 45Gy and all had one interstitial implantation followed by 3.75-5Gy×5 fractions in a twice daily (BID) schedule. Total doses for clinical target volume and organs at risk, including rectum, bladder, and sigmoid, were summated and normalized to a biologically equivalent dose of 2Gy per fraction. At 3 months posttherapy, early response was assessed with clinical examination and positron emission tomography (PET/CT) imaging.
  
  
  RESULTS
  Median clinical target volume D(90) (dose delivered to 90% of the clinical target volume) was 76.3 (59.0-86.9) Gy and the 2cc dose to the bladder, rectum, and sigmoid colon organs were 70.2 (55.9-77.7), 65.8 (54.9-80.6), and 56.5 (45.0-71.2) Gy, respectively. Posttreatment, 12 patients had evidence of persistent disease on PET/CT. Eleven of the 35 patients who had complete response developed recurrences. Two patients developed late Radiation Therapy Oncology Group ≥3 rectal toxicities. Two-year actuarial local control, disease-free survival, overall survival, and Grade ≥3 toxicities were 61%, 43%, 59%, and 10%, respectively.
  
  
  CONCLUSIONS
  Our approach of a single implantation procedure followed by five fractions of HDRBT was well tolerated with early results demonstrating a moderate response and local control rate with acceptable toxicities.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA.
authors.forename: Neeta
authors.initials: N
authors.lastname: Kannan
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: Hayeon
authors.initials: H
authors.lastname: Kim
authors.forename: Christopher
authors.initials: C
authors.lastname: Houser
authors.forename: Robert
authors.initials: R
authors.lastname: Mogus
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Olawaiye
authors.forename: Scott
authors.initials: S
authors.lastname: Richard
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011829:Radiation Dosage; D012007:Rectum / Q000473:pathology; D001743:Urinary Bladder / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D014621:Vagina / Q000473:pathology*