title: Treatment results of image-guided high-dose-rate interstitial brachytherapy for pelvic recurrence of uterine cancer.
abstract: OBJECTIVE
  We analyzed clinical data to evaluate the effectiveness of image-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for pelvic recurrence of uterine cancer.
  
  
  METHODS
  Between 2003 and 2011, 56 patients were treated with HDR-ISBT with or without external beam radiotherapy (EBRT). The median followup time was 33 months (range, 1-109 months). Pre-ISBT treatments included radical hysterectomy for 35 patients (Group A), radical hysterectomy with postoperative radiotherapy for 8 patients (Group B), and radical radiotherapy for 13 patients (Group C). We initiated MRI-assisted CT-based planning for the last 49 patients. The median ISBT single fraction dose was 6 Gy. The median total doses were 30 and 54 Gy with and without EBRT (range, 30-50 Gy) for Group A, respectively and 48 Gy without EBRT for Groups B and C.
  
  
  RESULTS
  The 3-year local control (LC) rates were 85%, 75%, and 46% for Groups A, B, and C, respectively (p = 0.017). The 3-year LC rates were 84%, 73%, and 33% for clinical target volume at the time of HDR-ISBT of <10, 10-29, and ≥30 cc, respectively (p = 0.005). The 3-year LC results tended to be higher for patients whose D100 (clinical target volume) was equal or higher than 67.1 Gy (p = 0.098). A total of 13 late complications of Grades 3-5 occurred in 11 patients (20%).
  
  
  CONCLUSIONS
  Our image-guided HDR-ISBT for pelvic recurrence of uterine cancer provided good treatment outcomes. The treatment results for patients who underwent radical surgery with or without postoperative radiotherapy are better than those for patients who underwent radical radiotherapy.
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan. Electronic address: rad113@poh.osaka-med.ac.jp.
authors: Ken
authors: K
authors: Yoshida
authors: Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Hideya
authors: H
authors: Yamazaki
authors: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors: Tadayuki
authors: T
authors: Kotsuma
authors: Department of Radiology, National Hospital Organization Himeji Medical Center, Himeji, Japan.
authors: Tadashi
authors: T
authors: Takenaka
authors: Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Koji
authors: K
authors: Masui
authors: Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Yasuo
authors: Y
authors: Yoshioka
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Yasuo
authors: Y
authors: Uesugi
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Taiju
authors: T
authors: Shimbo
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Nobuhiko
authors: N
authors: Yoshikawa
authors: Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Hiroto
authors: H
authors: Yoshioka
authors: Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Yoshifumi
authors: Y
authors: Narumi
authors: Department of Obstetrics and Gynecology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors: Keiji
authors: K
authors: Tatsumi
authors: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors: Eiichi
authors: E
authors: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000628:therapy*
keywords: High-dose-rate interstitial brachytherapy; Image guided; Magnetic resonance imaging; Pelvic recurrence; Uterine cancer