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Carcinoma of the Uterine Cervix: Twice- versus Once-weekly High-Dose-Rate Brachytherapy¹

¹ From the Department of Radiology, Division of Radiation Oncology (Y.H., M.U., A. Shioda, A. Suda, M.K., T.T., S.K.), Obstetrics and Gynecology (I.N.), and Public Health (Y.S.), National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan. From the 1999 RSNA scientific assembly. Received April 12, 2000; revision requested June 6; revision received July 21; accepted August 29. Address correspondence to M.U.

PURPOSE: To compare the effectiveness and safety of once- versus twice-weekly high–dose-rate (HDR) brachytherapy for cervical cancer.

MATERIALS AND METHODS: From 1980 to 1997, 124 consecutive previously untreated patients with cervical cancer were treated with external-beam irradiation (50 Gy) and HDR brachytherapy. Clinical stages were I, 4 (3%) patients; II, 51 (41%); III, 64 (52%); and IV, 5 (4%). From 1980 to 1992, 74 patients (group A) were treated with HDR brachytherapy once weekly (about three fractions of 7 Gy each to point A [2 cm superior and 2 cm lateral to the inferior end of the intrauterine radioactive source]), while from 1992 to 1997, 50 patients (group B) were treated twice weekly (about six fractions of 4.5 Gy each to point A).

RESULTS: Overall survival rate at 5 years was 65.2% in group A and 65.3% in group B (P = .96). Local recurrence-free survival rate at 5 years was 69% (51 of 74 patients) in group A and 90% (45 of 50 patients) in group B (P < .001). The rate of grade 2 (moderate) and grade 3 (severe) complications was significantly lower in group B (6% vs 32% in group A, P < .001). At multivariate analysis, the variables significantly associated with increased local-regional recurrence rates were having stage III–IV lesions (P = .04) and with fewer than six sessions of HDR brachytherapy (P = .02).

CONCLUSION: The twice-weekly HDR regimen may improve the local control rate with fewer complications.

Index terms: Radiations, injurious effects, complications of therapeutic radiology, 854.1269 • Radiobiology, time-dose studies • Therapeutic radiology, interstitial and intracavitary, 854.1269 • Uterine neoplasms, 854.32

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				S.-W. Chen, J.-A. Liang, S.-N. Yang, and F.-J. Lin High Dose-rate Brachytherapy for Elderly Patients with Uterine Cervical Cancer Jpn. J. Clin. Oncol., May 1, 2003; 33(5): 221 - 228. [Abstract] [Full Text] [PDF]