title: Phase II trial of image-based high-dose-rate interstitial brachytherapy for previously irradiated gynecologic cancer.
abstract: OBJECTIVE
  To report the disease-free Grade ≥3 complication-free survival of a Phase II protocol of reirradiation with high-dose-rate (HDR) interstitial brachytherapy (ITB) in previously irradiated gynecologic cancer.
  
  
  METHODS
  Fifteen patients with previously irradiated cervical (n = 6), endometrial (n = 6), and vulvovaginal tumors (n = 3) were treated with HDR-ITB alone to a median dose of 38 Gy in 8 b.i.d. fractions over 4 consecutive days. Prior treatments included surgery (n = 12; 80%), external irradiation (n = 15; 100%), and brachytherapy (n = 9; 60%). Average clinical target volume Size was 60.9 cc (range, 14.8-165.3 cc), and median time to reirradiation was 3.9 years (range, 0.4-22.7 years).
  
  
  RESULTS
  With a median followup of 2.8 years (range, 1.2-9.2 years), 3 patients (20.0%) developed Grade ≥3 toxicity consisting of Grade 3 intestinal obstruction (n = 1), Grade 4 rectovesical fistula (n = 1), and Grade 5 intestinal obstruction (n = 1). Six patients remain alive and without evidence of disease at last followup. Two patients are alive with disease progression, and 7 patients have died, 4 of them from disease progression and 3 from other causes. The 2-year disease-free Grade ≥3 complication-free survival was 40%.
  
  
  CONCLUSIONS
  HDR-ITB alone is a reasonable salvage treatment option in a significant number of patients with previously irradiated gynecologic tumors.
authors.affiliation: Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain. Electronic address: rmartinezm@unav.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
authors.affiliation: Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cambeiro
authors.affiliation: Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain.
authors.forename: María E
authors.initials: ME
authors.lastname: Rodríguez-Ruiz
authors.affiliation: Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Olarte
authors.affiliation: Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain.
authors.forename: Luis I
authors.initials: LI
authors.lastname: Ramos
authors.affiliation: Department of Radiation Oncology, Hospital de Navarra, Pamplona, Navarre, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Villafranca
authors.affiliation: Department of Radiation Oncology, Hospital Clínico Universitario, Zaragoza, Spain.
authors.forename: Natividad
authors.initials: N
authors.lastname: Bascón
authors.affiliation: Department of Gynaecology, University of Navarra, Pamplona, Navarre, Spain.
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000379:methods*
keywords: Gynecologic tumors; Interstitial high-dose-rate brachytherapy; Prior irradiation