High-dose-rate intracavitary radiotherapy in the management of cervical intraepithelial neoplasia 3 and carcinoma in situ presenting with poor histologic factors after undergoing excisional procedures.
OBJECTIVE
To assess the effectiveness of high-dose-rate intracavitary radiotherapy (HDR-ICR) in patients with cervical intraepithelial neoplasia 3 (CIN 3) and carcinoma in situ (CIS) presenting with poor histologic factors for predicting residual disease after undergoing diagnostic excisional procedures.


METHODS
This study was a retrospective analysis of 166 patients with CIN 3 (n=15) and CIS (n=151) between October 1986 and December 2005. They were diagnosed by conization (n=158) and punch biopsy (n=8). Pathologic analysis showed 135 cases of endocervical gland involvement (81.4%), 74 cases of positive resection margins (44.5%), and 52 cases of malignant cells on endocervical curettage (31.3%). All patients were treated with HDR-ICR using Co⁶⁰ or Ir¹⁹² at a cancer center. The dose was prescribed at point A located 2 cm superior to the external os and 2 cm lateral to the axis of the tandem for intact uterus.


RESULTS
Median age was 61 years (range, 29-77). The median total dose of HDR-ICR was 30 Gy/6 fractions (range, 30-52). At follow-up (median, 152 months), 2 patients developed recurrent diseases: 1 CIN 2 and 1 invasive carcinoma. One hundred and forty patients survived and 26 patients died, owing to nonmalignant intercurrent disease. Rectal bleeding occurred in one patient; however, this symptom subsided with conservative management.


CONCLUSIONS
Our data showed HDR-ICR is an effective modality for CIN 3 and CIS patients presenting with poor histologic factors after excisional procedures. HDR-ICR should be considered as a definitive treatment in CIN 3 and CIS patients with possible residual disease after undergoing excisional procedures.
Department of Radiation Oncology, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea. ybkim3@yuhs.ac
Yong Bae
YB
Kim
Young Tae
YT
Kim
Nam Hoon
NH
Cho
Woong Sub
WS
Koom
Sunghoon
S
Kim
Sang Wun
SW
Kim
Eun Ji
EJ
Nam
Gwi Eon
GE
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D018365:Neoplasm, Residual; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
D003037:Cobalt Radioisotopes; D007496:Iridium Radioisotopes