title: Ultrasound-assisted endocavitary HDR-Ir(192) brachytherapy for unresectable locally advanced uterine cervix carcinoma: retrospective analysis focusing the efficacy and tolerability.
abstract: OBJECTIVE
  To evaluate the impact of uterine cavity's ultrasound to final selected length of intracavitary tandem. The efficacy and tolerability of external beam radiation plus HDR-Ir(192) brachytherapy in our cohort of patients were also estimated.
  
  
  METHODS
  48 women with locally advanced unresectable uterine cervix carcinoma were treated by HDR-Ir(192) endocavitary brachytherapy between January 2007 and January 2009. The median age was 63 (range 38-74). The distribution according to Federation of Gynaecology and Obstetrics (FIGO) staging system was as follows: Stage IIB, 54.16 %; IIIA, 10.4 %; IIIB, 27.0 %; and IVA, 8.3 %. HDR intracavitary brachytherapy was given weekly, beginning at the last week of whole pelvis irradiation, with a dose of 7 Gy to point A for three to four fractions. The median overall treatment time was 50 days (range 42-73 days). The median follow-up time was 2.7 years (range 3 months to 4.9 years). Multivariate analysis was performed using the Cox regression proportional hazards model.
  
  
  RESULTS
  The complete remission rate after radiotherapy was 93.75 % (45/48). The 5-year actuarial major complication rates (Grade 3 or above) were 6.3 % overall (2.1 % proctitis, 2.1 % cystitis and 2.1 % enteritis). Estimation of the length of uterine cavity by ultrasound helped decisively in the proper placement of the intrauterine tandem inserted.
  
  
  CONCLUSIONS
  Prior knowledge of the length of uterine cavity can facilitate the decisions regarding the proper insertion length of the tandem. Results of cervical cancer treatment with external beam radiation and HDR intracavitary brachytherapy in our hospital are encouraging.
authors.affiliation: Department of Second Radiation Therapy, Saint Savvas Anticancer Institute of Athens, Athens, Greece. gkoyokoyrakis@yahoo.gr
authors.forename: Georgios V
authors.initials: GV
authors.lastname: Koukourakis
authors.forename: Anthoula
authors.initials: A
authors.lastname: Miliadou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsalafoutas
authors.forename: Myrsini G
authors.initials: MG
authors.lastname: Gkeli
authors.forename: Elisavet
authors.initials: E
authors.lastname: Geli
authors.forename: Anastasia
authors.initials: A
authors.lastname: Sotiropoulou-Lontou
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014463:Ultrasonography; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000532:radiotherapy*
chemical_list: D007496:Iridium Radioisotopes