title: High-dose-rate intra-cavitary brachytherapy combined with external beam radiation therapy for under 40-year-old patients with invasive uterine cervical carcinoma: clinical outcomes in 118 Patients in a Japanese multi-institutional study, JASTRO.
abstract: BACKGROUND
  The current study was designed to evaluate the clinical outcomes of curative intent radiation therapy for young patients with invasive uterine cervical carcinoma in Japan.
  
  
  METHODS
  One hundred and eighteen patients aged ≤40 were registered in the multi-institutional study of the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) from 26 major institutions in Japan. The age range was 24-39 years and the maximum tumor diameter was 2.0-9.2 cm. The International Federation of Gynecology and Obstetrics clinical stages were Ib, IIa, IIb, IIIa, IIIb and IVa in 17, 6, 40, 2, 50 and 3, respectively. Curative intent radiation therapy consisted of the combination of external beam radiation therapy and high-dose rate intra-cavitary brachytherapy. The total dose of external beam radiation therapy ranged between 44 and 68 Gy. Both the median and mode of total high-dose-rate intra-cavitary brachytherapy dose to point A were 24 Gy in four fractions. Ninety-six patients (58%) received chemotherapy.
  
  
  RESULTS
  The 5-year overall survival rate and local control rate of all patients were 61 and 65%, respectively. The 5-year overall survival rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 88, 100, 75, 100, 37 and 0%, respectively. The 5-year local control rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 82, 75, 75, 100, 51 and 0%, respectively. Sixteen patients experienced grade 3 or greater late radiation morbidity.
  
  
  CONCLUSIONS
  The 5-year overall survival rate of young patients with Stage IIIb was comparatively low at 37%.
authors.affiliation: Department of Radiology, University of Tokyo Hospital, Hongo, Tokyo, Japan. yamachan07291973@yahoo.co.jp
authors.forename: Hideomi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Niibe
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kazumoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Eto
authors.forename: Rumiko
authors.initials: R
authors.lastname: Kinoshita
authors.forename: Kayoko
authors.initials: K
authors.lastname: Tsujino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Onishi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Takemoto
authors.forename: Kazushige
authors.initials: K
authors.lastname: Hayakawa
mesh_terms: D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects; D003556:Cystitis / Q000209:etiology; D003872:Dermatitis / Q000209:etiology; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006402:Hematologic Diseases / Q000209:etiology; D006801:Humans; D007421:Intestine, Small / Q000528:radiation effects; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D011349:Proctitis / Q000209:etiology; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy*