title: Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer.
abstract: OBJECTIVE
  Incomplete brachytherapy is a major risk factor for recurrence. However, high-dose-rate intracavitary brachytherapy has not been assessed adequately in elderly patients with invasive cervical cancer. The present study investigated the clinical importance of intracavitary brachytherapy and risk factors of incomplete intracavitary brachytherapy in elderly patients with cervical cancer.
  
  
  METHODS
  Subjects were 76 patients aged 70-89 years old with invasive cervical cancer. All subjects were recruited between January 1997 and September 2010, and were planning to receive external beam radiation therapy followed by high-dose-rate intracavitary brachytherapy. Survival rates and the incidence of complications were compared between the 70s and 80s age groups. Risk factors for recurrence in elderly patients were evaluated using multivariate analysis, and risk factors for impractical intracavitary brachytherapy were also estimated.
  
  
  RESULTS
  No significant differences were observed in 3-year progression-free survival rates or the incidence of complications in the two age groups. Cox multivariate analysis showed that histology (non-squamous cell carcinoma), incomplete intracavitary brachytherapy, and lymph node swelling were significant prognostic factors for recurrence. Impractical application was the major reason for incomplete treatment. Multiple logistic regression analysis revealed that a previous history without vaginal births (P = 0.016) was an independent risk factor for the impractical application, independent of tumor diameter ≥ 4 cm (P = 0.007).
  
  
  CONCLUSIONS
  Incomplete intracavitary brachytherapy decreased the survival rates of elderly patients. Larger tumors and patients without a history of vaginal births were the two major causes of impractical intracavitary brachytherapy, which may be fatal, especially in elderly patients with bulky tumors.
authors.affiliation: Department of Obstetrics and Gynecology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Yanazume
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yanazume
authors.forename: Kazuto
authors.initials: K
authors.lastname: Iio
authors.forename: Ryuji
authors.initials: R
authors.lastname: Yonekura
authors.forename: Nobuko
authors.initials: N
authors.lastname: Kojima
authors.forename: Natsuko
authors.initials: N
authors.lastname: Uchida
authors.forename: Chihaya
authors.initials: C
authors.lastname: Koriyama
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Douchi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000706:statistics & numerical data*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy*
keywords: brachytherapy; cervical cancer; curative; elderly; radiotherapy