title: Outcome of 6 fractions of 5.3 Gray HDR brachytherapy in combination with external beam radiotherapy for treatment of cervical cancer.
abstract: OBJECTIVE
  To review the characteristics, outcomes and toxicities of cervical cancer patients treated with 6 fractions of brachytherapy after external beam radiotherapy (EBRT).
  
  
  METHODS
  All patients diagnosed with cervical cancer from 2000 to 2009 who were referred for radical treatment and who received 6 fractions of brachytherapy were retrospectively reviewed. Overall survival (OS), disease free survival (DFS), local control (LC), distant control (DC) rate, acute and late toxicities were the primary endpoints.
  
  
  RESULTS
  Thirty-two patients with mainly advanced stage squamous cell carcinoma were identified and reviewed. Patients received EBRT of 45 to 50.4 Gy in 1.8 Gy daily fractions followed by 6 sessions of 3 channel brachytherapy of 5.3 Gy prescribed to point H. Response rates to treatment were good, with no residual disease in 84% six weeks after the completion of treatment. With a median follow up time of 8.1 years, the five-year OS, DFS, LC and distant control rates were 75%, 68.5%, 92.8% and 76.9% respectively. None of the patients developed any G3-4 acute toxicity but one patient who had advanced disease developed G3-4 proctitis with a fistula formation.
  
  
  CONCLUSIONS
  HDR brachytherapy utilizing 6 fractions of 5.3 Gy prescribed to point H with concurrent chemo-radiation is superior in terms of OS and LC to regimens that deliver a lower EQD2 dose to point A/H and is associated with very low rates of toxicities.
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore. Electronic address: wee_yao_koh@nuhs.edu.sg.
authors.forename: Wee Yao
authors.initials: WY
authors.lastname: Koh
authors.forename: Keith
authors.initials: K
authors.lastname: Lim
authors.forename: Jeremy
authors.initials: J
authors.lastname: Tey
authors.forename: Khai Mun
authors.initials: KM
authors.lastname: Lee
authors.forename: Gek Hsiang
authors.initials: GH
authors.lastname: Lim
authors.forename: Bok Ai
authors.initials: BA
authors.lastname: Choo
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002908:Chronic Disease; D002945:Cisplatin / Q000627:therapeutic use; D003556:Cystitis / Q000209:etiology; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D011349:Proctitis / Q000209:etiology; D011832:Radiation Injuries / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Brachytherapy; Cervical cancer; Long fractionation