title: Reirradiation using high-dose-rate interstitial brachytherapy for locally recurrent cervical cancer: a single institutional experience.
abstract: OBJECTIVE
  This study aimed to evaluate the effectiveness and feasibility of reirradiation using high-dose-rate interstitial brachytherapy (HDR-ISBT) in patients with recurrent cervical cancer.
  
  
  METHODS
  The records of 52 consecutive women with central pelvic recurrence who were salvaged with HDR-ISBT-based reirradiation were retrospectively reviewed. Data regarding the primary disease, follow-up findings, recurrence, the treatment outcome, and toxicities were collected. Multivariate analysis was performed using the Cox proportional hazards regression model to identify predictors of the response to HDR-ISBT. Survival rate was calculated using the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  A total of 52 patients who had been treated with HDR-ISBT-based reirradiation were included in our database. The local control rate was 76.9% (40/52), and the median postrecurrence survival period was 32 months. Grade 3 or 4 late toxicities were observed in 13 patients (25%). Multivariate analysis revealed that tumor size and the treatment-free interval were significant poor prognostic factors of postrecurrence survival. In a comparison between the patients who were salvaged with HDR-ISBT-based reirradiation (ISBT group) and those who were treated with palliative therapy alone (palliative group), we found that among the patients who displayed 0 or 1 poor prognostic factors, the patients in the ISBT group survived significantly longer than those in the palliative group. In contrast, similar survival rates were seen in both groups among the patients with 2 or more poor prognostic factors.
  
  
  CONCLUSIONS
  Reirradiation using HDR-ISBT is effective and feasible in patients with recurrent cervical cancer. Our 2-clinical variable prognostic model might enable physicians to identify patients who would not derive clinical benefit from HDR-ISBT and offer them the opportunity to receive other types of treatment.
authors.affiliation: Departments of *Obstetrics and Gynecology, and †Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Mabuchi
authors.forename: Ryoko
authors.initials: R
authors.lastname: Takahashi
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Isohashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yokoi
authors.forename: Mika
authors.initials: M
authors.lastname: Okazawa
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sasano
authors.forename: Shintaroh
authors.initials: S
authors.lastname: Maruoka
authors.forename: Makoto
authors.initials: M
authors.lastname: Anzai
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yoshioka
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D010166:Palliative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*