Volume-based pulsed-dose-rate brachytherapy boosting concurrent chemoradiation as a definitive treatment modality in cervical cancer.
OBJECTIVE
To report the treatment outcomes and treatment-induced adverse events (AEs) of concomitant chemoradiotherapy boosted with pulsed-dose-rate brachytherapy using volume-based two-dimensional planning in patients with cervical cancer.


METHODS
After obtaining the institutional review board approval, patients with FIGO Stages IB to IIIB cervical cancer, treated from January 2006 to December 2008 consecutively, were included. Volume-based planning was used and entailed defining an envelope around the tumor on a two-dimensional image and prescribing the dose to this envelope and reporting the dose of the isodose of 60 Gy. Patients and tumor characteristics, dosimetric parameters, AEs and treatment outcomes, local control rate, distant metastases rate, progression-free survival, and overall survival are reported.


RESULTS
The study included 95 patients; the median age is 50 years. The median tumor size is 50cc (range, 25-78cc). Median brachytherapy dose delivered to the envelope is 20 Gy (range, 15-35 Gy), and median volume encompassed by 60 Gy isodose curve is 137cc (range, 26-365cc). The 3-year overall survival, progression-free survival, local control rate, and distant metastases rate were 83.8%, 72.4%, 84.8%, and 15.4%, respectively. Gastrointestinal and genitourinary Grade 3 and 4 acute AEs were reported in 11.6% and 3.3% and chronic Grade 3 and 4 AEs were reported in 3.2% and 4.2% of all patients, respectively.


CONCLUSIONS
Chemoradiotherapy followed by pulsed-dose-rate brachytherapy boost is effective and tolerable treatment modality for locally confined cervical cancer.
Département Universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France; Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Tamer
T
Refaat
Département Universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France.
Philippe
P
Nickers
Département Universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France. Electronic address: e-lartigau@o-lambret.fr.
Eric
E
Lartigau
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
D000970:Antineoplastic Agents
Brachytherapy; Cervix; Pulsed-dose-rate