title: Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience.
abstract: OBJECTIVE
  To evaluate the outcomes of image-guided brachytherapy combined with 3D conformal or intensity modulated external beam radiotherapy (3D CRT/IMRT) in cervical cancer at Chiang Mai University.
  
  
  METHODS
  From 2008 to 2011, forty-seven patients with locally advanced cervical cancer were enrolled in this study. All patients received high-technology (3D CRT/IMRT) whole pelvic radiotherapy with a total dose of 45-46 Gy plus image-guided High-Dose-Rate intracavitary brachytherapy 6.5-7 Gy × 4 fractions to a High-Risk Clinical Target Volume (HR-CTV) according to GEC-ESTRO recommendations. The dose parameters of the HR-CTV for bladder, rectum and sigmoid colon were recorded, as well as toxicity profiles. In addition, the endpoints for local control, disease-free, metastasis-free survival and overall survival were calculated.
  
  
  RESULTS
  At the median follow-up time of 26 months, the local control, disease-free survival, and overall survival rates were 97.9%, 85.1%, and 93.6%, respectively. The mean dose of HR-CTV, bladder, rectum and sigmoid were 93.1, 88.2, 69.6, and 72 Gy, respectively. In terms of late toxicity, the incidence of grade 3-4 bladder and rectum morbidity was 2.1% and 2.1%, respectively.
  
  
  CONCLUSIONS
  A combination of image-guided brachytherapy and IMRT/3D CRT showed very promising results of local control, disease-free survival, metastasis-free survival and overall survival rates. It also caused a low incidence of grade 3-4 toxicity in treated study patients.
authors.affiliation: The division of therapeutic radiology and oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. paan_31@hotmail.com
authors.forename: Ekkasit
authors.initials: E
authors.lastname: Tharavichitkul
authors.forename: Somvilai
authors.initials: S
authors.lastname: Chakrabandhu
authors.forename: Somsak
authors.initials: S
authors.lastname: Wanwilairat
authors.forename: Damrongsak
authors.initials: D
authors.lastname: Tippanya
authors.forename: Wannapha
authors.initials: W
authors.lastname: Nobnop
authors.forename: Nantaka
authors.initials: N
authors.lastname: Pukanhaphan
authors.forename: Razvan M
authors.initials: RM
authors.lastname: Galalae
authors.forename: Imjai
authors.initials: I
authors.lastname: Chitapanarux
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin