title: Early clinical outcomes of ultrasound-guided CT-planned high-dose-rate interstitial brachytherapy for primary locally advanced cervical cancer.
abstract: OBJECTIVE
  To report early clinical outcomes of high-dose-rate interstitial image-guided brachytherapy (BT) in the definitive management of locally advanced cervical cancer.
  
  
  METHODS
  We retrospectively analyzed 31 locally advanced cervical cancer patients treated at our institution between January 2010 and April 2013. About 88% had advanced disease based on the International Federation of Gynecology and Obstetrics guidelines, and 87% received concurrent chemotherapy. All patients were treated with external beam radiation therapy to a median dose of 45 Gy (range, 39.6-58 Gy) before receiving BT. High-dose-rate BT was delivered in a single implant to a median dose of 6 Gy × five fractions to a CT-defined volume. Median total equivalent 2-Gy dose, dose covered by 90% of the high-risk clinical target volume (HR-CTV D90), and HR-CTV were 84, 87.4, and 49.9 cc, respectively. Kaplan-Meier method was used for actuarial survival analysis, and toxicity was graded using Common Terminology Criteria for Adverse Events, version 4.0.
  
  
  RESULTS
  Median followup was 19.3 months. Two-year actuarial local control, regional control, and distant metastasis (DM) were 90%, 93%, and 23.6%, respectively. Two-year disease-free survival was 55%. Genitourinary, gastrointestinal, or gynecologic Grade 3 toxicity was seen in 5 patients (3 T4a and 2 T3b) for crude rates of 13%, 7%, and 3%, respectively. Stratifying HR-CTV by <30 and >30 cc and then by HR-CTV D90 of <85, 85-90, and >90 Gy showed that 100% of the local failures, regional failures, DM, and G3 toxicity occurred in >30 cc group. The rate of DM was also significantly higher in the >30 cc group (p = 0.036).
  
  
  CONCLUSIONS
  An interstitial approach can achieve excellent outcomes in cases where intracavitary and/or hybrid approaches are either not suitable or not available.
authors.affiliation: University of California Irvine School of Medicine, Irvine, CA.
authors.forename: Shane
authors.initials: S
authors.lastname: Mesko
authors.affiliation: Community Regional Medical Center, Fresno, CA.
authors.forename: Uma
authors.initials: U
authors.lastname: Swamy
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
authors.forename: Sang-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
authors.forename: Lalaine
authors.initials: L
authors.lastname: Borja
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
authors.forename: Jason
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA. Electronic address: Mkamrava@mednet.ucla.edu.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D041981:Gastrointestinal Tract / Q000528:radiation effects*; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014566:Urogenital System / Q000528:radiation effects*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult
keywords: Cervical cancer; High-dose-rate; Image-guided brachytherapy; Interstitial