title: Transition from LDR to HDR brachytherapy for cervical cancer: Evaluation of tumor control, survival, and toxicity.
abstract: In 2012, our institution transitioned from low-dose-rate (LDR) brachytherapy to high dose-rate (HDR) brachytherapy. We report clinical outcomes after brachytherapy for cervical cancer at our institution over a continuous 10-year period.
  
  
  
  From 2004 to 2014, 258 women (184 LDR and 74 HDR) were treated with tandem and ovoid brachytherapy in the multidisciplinary management of International Federation of Gynecology and Obstetrics Stages IA-IVB cervical cancer. Clinical and treatment-related prognostic factors including age, stage, smoking status, relevant doses, and toxicity data were recorded.
  
  
  
  Median followup for the LDR and HDR groups was 46 months and 12 months, respectively. The majority of patients (92%) received external beam radiotherapy as well as concurrent chemotherapy (83%) before the start of brachytherapy. For all stages, the 1-year local control and overall survival (OS) rates were comparable between the LDR and HDR groups (87% vs. 81%, p = 0.12; and 75% vs. 85%, p = 0.16), respectively. Factors associated with OS on multivariate analysis include age, stage, and nodal involvement. On multivariate analysis, severe toxicity (acute or chronic) was higher with HDR than LDR (24% vs. 10%, p = 0.04). Additional prognostic factors associated with increased severe toxicity include former/current smokers and total dose to lymph nodes.
  
  
  
  This comparative retrospective analysis of a large cohort of women treated with brachytherapy demonstrates no significant difference in OS or local control between the LDR and HDR. Acute and chronic toxicity increased shortly after the implementation of HDR, highlighting the importance of continued refinement of HDR methods, including integrating advanced imaging.
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: K D
authors.initials: KD
authors.lastname: Romano
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: D M
authors.initials: DM
authors.lastname: Trifiletti
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: B
authors.initials: B
authors.lastname: Libby
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA. Electronic address: tns3b@virginia.edu.
authors.forename: T N
authors.initials: TN
authors.lastname: Showalter
mesh_terms: D000367:Age Factors; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012907:Smoking; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*
keywords: Brachytherapy; Cervical cancer; High dose rate; Low dose rate; Radiation therapy