A prospective cohort study to compare treatment results between 2 fractionation schedules of high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer.
OBJECTIVE
To compare the treatment results of 2 fractionation schedules for high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer.


METHODS
From June 2001 through January 2008, 267 patients with stage IB-IVA cervical cancer were enrolled in the study. All patients underwent 4-field pelvic irradiation and HDR-ICBT. The median central and parametrial doses were 39.6 Gy and 45 Gy, respectively. Patient underwent either 6 Gy×4 (HDR-4) (n=144) or 4.5 Gy×6 (HDR-6) (n=123) to point A of ICBT using 192Ir isotope twice weekly. The rates of overall survival, locoregional failure, distant metastasis, proctitis, cystitis, and enterocolitis were compared between HDR-4 and HDR-6.


RESULTS
There were no significant differences in the demographic data between HDR-4 and HDR-6 except for total treatment time. The 5-year proctitis rates were 23.0% and 21.5% in HDR-4 and HDR-6 (P=.399), respectively. The corresponding rates of grade 2-4 proctitis were 18.7% and 9.6% (P=.060). The corresponding rates of grades 3-4 proctitis were 5.2% and 1.3% (P=.231). Subgroup analysis revealed that HDR-4 significantly increased grade 2-4 proctitis in patients aged≥62 years old (P=.012) but not in patients aged<62 years (P=.976). The rates of overall survival, locoregional failure, distant metastasis, cystitis, and enterocolitis were not significantly different between HDR-4 and HDR-6 schedules.


CONCLUSIONS
The small fraction size of HDR-ICBT is associated with grade 2 proctitis without compromise of prognosis in elderly patients. This schedule is suggested for patients who tolerate an additional 2 applications of HDR-ICBT.
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Eng-Yen
EY
Huang
Li-Min
LM
Sun
Hao
H
Lin
Jen-Hong
JH
Lan
Chan-Chao
CC
Chanchien
Yu-Jie
YJ
Huang
Chang-Yu
CY
Wang
Chong-Jong
CJ
Wang
D000367:Age Factors; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D003556:Cystitis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D019583:Dose Fractionation, Radiation; D004760:Enterocolitis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011349:Proctitis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D011832:Radiation Injuries / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*
D007496:Iridium Radioisotopes