title: Ultrasound guided conformal brachytherapy of cervix cancer: survival, patterns of failure, and late complications.
abstract: OBJECTIVE
  The aim of this study was to report on the long-term results of transabdominal ultrasound guided conformal brachytherapy in patients with cervical cancer with respect to patterns of failures, treatment related toxicities and survival.
  
  
  METHODS
  Three hundred and nine patients with cervical cancer who presented to Institute between January 1999 and December 2008 were staged with magnetic resonance imaging and positron emission tomography and treated with external beam radiotherapy and high dose rate conformal image guided brachytherapy with curative intent. Follow-up data relating to sites of failure and toxicity was recorded prospectively.
  
  
  RESULTS
  Two hundred and ninety-two patients were available for analyses. The median (interquantile range) follow-up time was 4.1 years (range, 2.4 to 6.1 years). Five-year failure free survival and overall survival (OS) were 66% and 65%, respectively. Primary, pelvic, para-aortic, and distant failure were observed in 12.5%, 16.4%, 22%, and 23% of patients, respectively. In multivariate analysis, tumor volume and nodal disease related to survival, whereas local disease control and point A dose did not.
  
  
  CONCLUSIONS
  Ultrasound guided conformal brachytherapy of cervix cancer has led to optimal local control and OS. The Melbourne protocol compares favorably to the more technically elaborate and expensive GEC-ESTRO recommendations. The Melbourne protocol's technical simplicity with real-time imaging and treatment planning makes this a method of choice for treating patients with cervical cancer.
authors.affiliation: Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, VIC, Australia.
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
authors.affiliation: Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van Dyk
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Bernshaw
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Pearly
authors.initials: P
authors.lastname: Khaw
authors.affiliation: Division of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.affiliation: Rural Clinical School, The University of Queensland School of Medicine, Toowoomba, QLD, Australia.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011829:Radiation Dosage; D011859:Radiography; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D017211:Treatment Failure; D018084:Ultrasonography, Interventional / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Brachytherapy; Cervix; Image-guided radiotherapy; Neoplasms; Radiation effects