title: Salvage interstitial brachytherapy based on computed tomography for recurrent cervical cancer after radical hysterectomy and adjuvant radiation therapy: case presentations and introduction of the technique.
abstract: OBJECTIVE
  Locally recurring cervical cancer after surgery and adjuvant radiotherapy remains a major therapeutic challenge. This paper presents a new therapeutic technique for such patients: interstitial brachytherapy (BT) guided by real-time three-dimensional (3D) computed tomography (CT).
  
  
  METHODS
  Sixteen patients with recurrent cervical cancer after radical surgery and adjuvant external-beam radiotherapy (EBRT) were included in this study. These patients underwent high-dose-rate (HDR) interstitial BT with free-hand placement of metal needles guided by real-time 3D-CT. Six Gy in 6 fractions were prescribed for the high-risk clinical target volume (HR-CTV). D90and D100for HR-CTV of BT, and the cumulative D2ccfor the bladder, rectum, and sigmoid, including previous EBRT and present BT were analyzed. Treatment-related complications and 3-month tumor-response rates were investigated.
  
  
  RESULTS
  The mean D90value for HR-CTV was 52.5 ± 3.3 Gy. The cumulative D2ccfor the bladder, rectum, and sigmoid were 85.6 ± 5.8, 71.6 ± 6.4, and 69.6 ± 5.9 Gy, respectively. The mean number of needles was 6.1 ± 1.5, with an average depth of 3.5 ± 0.9 cm for each application. Interstitial BT was associated with minor complications and passable tumor-response rate.
  
  
  CONCLUSIONS
  Interstitial BT guided by real-time 3D-CT for recurrent cervical cancer results in good dose-volume histogram (DVH) parameters. The current technique may be clinically feasible. However, long-term clinical outcomes should be further investigated.
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun.
authors.forename: Zhong-Shan
authors.initials: ZS
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun.
authors.forename: Jie
authors.initials: J
authors.lastname: Guo
authors.affiliation: Cancer Center, The First Affiliated Hospital of Jilin University, Changchun.
authors.forename: Yang-Zhi
authors.initials: YZ
authors.lastname: Zhao
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun.
authors.forename: Xia
authors.initials: X
authors.lastname: Lin
authors.affiliation: Department of Nuclear Medicine, The Third Affiliated Hospital of Jilin University, Changchun.
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Radiology, the General Hospital of Hegang Mining Industry Group Co., Ltd, Hegang.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, The 313 Hospital of People's Liberation Army, Huludao, China.
authors.forename: Jiang-Ming
authors.initials: JM
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Ren
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun.
authors.forename: Bing-Ya
authors.initials: BY
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, Changchun.
authors.forename: Tie-Jun
authors.initials: TJ
authors.lastname: Wang
keywords: cervical cancer; computed tomography; interstitial brachytherapy; recurrence