title: HDR brachytherapy for the reirradiation of cervical and vaginal cancer: analysis of efficacy and dosage delivered to organs at risk.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of HDR brachytherapy (BT) for the reirradiation of cervical or vaginal cancer arising within a previously irradiated area with a special focus on dosage delivery to organs at risk.
  
  
  METHODS
  Twenty consecutive patients with cervical (N = 19) or vaginal (N = 1) cancer were reirradiated with curative intent using BT with or without external beam irradiation and hyperthermia. The median biologically equivalent dose in 2 Gy fractions (EQD2), assuming α/β = 10, for reirradiation was 48.8 Gy (range: 16.0-91.0 Gy), and the median cumulative EQD2 (for primary treatment and reirradiation) was 133.5 Gy (range: 96.8-164.2 Gy). The median follow-up after retreatment was 31 months (range: 6-86 months).
  
  
  RESULTS
  The 3-year overall survival (OS) rate was 68% (95% confidence interval [CI]: 44%-91%). The 3-year disease-free survival (DFS) rate was 42% (95% CI: 19%-65%). The 3-year local control (LC) rate was 45% (95% CI: 22%-69%). For nine patients who received 3D treatment planning, the median cumulative EQD2 to 2 cm(3) of rectum was 94.4 Gy (range: 67.1-118.8 Gy) and to 2 cm(3) of bladder was 99.3 Gy (range: 70.4-122.3 Gy). Grade 3 late toxicity was observed in 3 patients (15%). An interval between primary RT and reirradiation of ≤ 12 months and a tumor diameter >3 cm were significant prognostic factors adversely affecting OS, DFS and LC.
  
  
  CONCLUSIONS
  HDR BT is a valuable method for the reirradiation of cervical cancer. A cumulative EQD2 of approximately 100 Gy was safely delivered to 2 cm(3) of the bladder and the rectum.
authors.affiliation: Department of Brachytherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. Electronic address: agnieszka.zolciak@wp.pl.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Zolciak-Siwinska
authors.affiliation: Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Bijok
authors.affiliation: Department of Radiotherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Jonska-Gmyrek
authors.affiliation: Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kawczynska
authors.affiliation: Department of Radiotherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Kepka
authors.affiliation: Department of Radiotherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bujko
authors.affiliation: Department of Clinical Trials and Biostatistics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Michalski
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D014625:Vaginal Neoplasms / Q000401:mortality / Q000532:radiotherapy*
keywords: Brachytherapy; Cervical cancer; Recurrence; Reirradiation; Vaginal cancer