The Results of High-dose Rate Intracavitary Brachytherapy for Uterine Cervical Carcinoma in Ramathibodi Hospital
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Abstract
Objectives: To study results of high-dose-rate brachytherapy (HDR-BCT) for the treatment of cervical cancer patients in Ramathibodi Hospital in terms of tumor control, survival and treatment complications and to identify factors that may impact on local control.
Materials and Methods: Retrospective analysis was performed on patients with stage IA-IVA cervical cancer treated with a combination of external beam radiotherapy (EBRT) and HDR-BCT in Ramathibodi hospital during March 1999 to June 2001. The Kaplan-Meier method was used for survival analysis. Univariate and Multivariate analysis was performed using log-rank test and Cox proportional hazard regression model to identify factors associated with local control rates.
Results: There were 263 patients included in this study (5.3% stage I, 52.8% stage II, 41.8% stage II). The median follow-up time was 66 months (3-113 months). Seventy-one patients (27%) were lost to follow-up. Chemotherapy was delivered in 45 patients. Early stage patients received 40-50.4 Gy whole pelvic EBRT plus 3-4 intracavitary brachytherapy sessions with a fraction size of 3-7 Gy. Patients with advanced stage underwent EBRT to the pelvis to a dose of 40-60 Gy followed by 2-4 sessions of HDR- BCT of 4-7.5 Gy. Median low-dose-rate equivalent dose at point A was 73 Gy and 75 Gy in early and advanced stage, respectively. The 5-year overall survival, disease-free, and local control rates for all patients were 70%, 70%, and 80%, respectively. The 5-year LC rates according to stage were 92% in early stage and 77% in advanced stage. Stage and quality of brachytherapy were independent prognostic factors of local control. Severe (grade 3 and 4) late GI and GU complication rates were 3.1%, and 1.6%, respectively.
Conclusion: The combination of EBRT and HDR-BCT, as used in Ramathibodi hospital, can produce favorable outcome and acceptable rates of late complication when compared to other centers in treatment of cervical cancer.
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References
Khuhaprema T, Srivatanakul P, Sriplung H, Wiangnon S, Sumitsawan Y, Attasara P. Cancer in Thailand Volume IV 1998–2000. Bangkok: National Cancer Institute, Ministry of Public Health; 2007.
Ramathibodi Cancer Registry. Cancer Report 2003-2005. Bangkok: Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2005.
Brenner DJ. Radiation biology in brachytherapy. J Surg Oncol. 1997;65(1):66-70. doi:10.1002/(sici)1096-9098(199705)65:1<66::aid-jso13>3.0.co;2-q.
Hareyama M, Sakata K, Oouchi A, Nagakura H, Shido M, Someya M, et al. High-dose-rate versus low-dose-rate intracavitary therapy for carcinoma of the uterine cervix: a randomized trial. Cancer. 2002;94(1):117-124. doi:10.1002/cncr.10207.
Lertsanguansinchai P, Lertbutsayanukul C, Shotelersuk K, Khorprasert C, Rojpornpradit P, et al. Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma. Int J Radiat Oncol Biol Phys. 2004;59(5):1424-1431. doi:10.1016/j.ijrobp.2004.01.034.
Shigematsu Y, Nishiyama K, Masaki N, Inoue T, Miyata Y, Ikeda H, et al. Treatment of carcinoma of the uterine cervix by remotely controlled afterloading intracavitary radiotherapy with high-dose rate: a comparative study with a low-dose rate system. Int J Radiat Oncol Biol Phys. 1983;9(3):351-356. doi:10.1016/0360-3016(83)90295-x.
Teshima T, Inoue T, Ikeda H, Miyata Y, Nishiyama K, Inoue T, et al. High-dose rate and low-dose rate intracavitary therapy for carcinoma of the uterine cervix. Final results of Osaka University Hospital. Cancer. 1993;72(8):2409-2414. doi:10.1002/1097-0142(19931015)72:8<2409::aid-cncr2820720819>3.0.co;2-n.
Falkenberg E, Kim RY, Meleth S, De Los Santos J, Spencer S. Low-dose-rate vs. high-dose-rate intracavitary brachytherapy for carcinoma of the cervix: The University of Alabama at Birmingham (UAB) experience. Brachytherapy. 2006;5(1):49-55. doi:10.1016/j.brachy.2005.12.001.
Ferrigno R, Nishimoto IN, Novaes PE, Pellizzon AC, Maia MA, Fogarolli RC, et al. Comparison of low and high dose rate brachytherapy in the treatment of uterine cervix cancer. Retrospective analysis of two sequential series. Int J Radiat Oncol Biol Phys. 2005;62(4):1108-1116. doi:10.1016/j.ijrobp.2004.12.016.
Han I, Malviya V, Chuba P, Orton C, Devi S, Deppe G, et al. Multifractionated high-dose-rate brachytherapy with concomitant daily teletherapy for cervical cancer. Gynecol Oncol. 1996;63(1):71-77. doi:10.1006/gyno.1996.0281.
Lorvidhaya V, Tonusin A, Changwiwit W, Chitapanarux I, Srisomboon J, Wanwilairat S, et al. High-dose-rate afterloading brachytherapy in carcinoma of the cervix: an experience of 1992 patients. Int J Radiat Oncol Biol Phys. 2000;46(5):1185-1191. doi:10.1016/s0360-3016(99)00383-1.
Nakano T, Kato S, Ohno T, Tsujii H, Sato S, Fukuhisa K, et al. Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix. Cancer. 2005;103(1):92-101. doi:10.1002/cncr.20734.
Patel FD, Rai B, Mallick I, Sharma SC. High-dose-rate brachytherapy in uterine cervical carcinoma. Int J Radiat Oncol Biol Phys. 2005;62(1):125-130. doi:10.1016/j.ijrobp.2004.09.017.
Toita T, Kakinohana Y, Ogawa K, Adachi G, Moromizato H, Nagai Y, et al. Combination external beam radiotherapy and high-dose-rate intracavitary brachytherapy for uterine cervical cancer: analysis of dose and fractionation schedule. Int J Radiat Oncol Biol Phys. 2003;56(5):1344-1353. doi:10.1016/s0360-3016(03)00288-8.
Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 2000;48(1):201-211. doi:10.1016/s0360-3016(00)00497-1.
Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70(2):209-262.
International Commission on Radiation Units and Measurements (ICRU) Report 38. Dose and volume specification for reporting intracavitary brachytherapy in gynecology. Bethesda, MD: ICRU; 1985:1-20.
Nag S, Gupta N. A simple method of obtaining equivalent doses for use in HDR brachytherapy. Int J Radiat Oncol Biol Phys. 2000;46(2):507-513. doi:10.1016/s0360-3016(99)00330-2.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341-1346. doi:10.1016/0360-3016(95)00060-C.
Petereit DG, Pearcey R. Literature analysis of high dose rate brachytherapy fractionation schedules in the treatment of cervical cancer: is there an optimal fractionation schedule?. Int J Radiat Oncol Biol Phys. 1999;43(2):359-366. doi:10.1016/s0360-3016(98)00387-3.
Atahan IL, Onal C, Ozyar E, Yiliz F, Selek U, Kose F. Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study. Int J Gynecol Cancer. 2007;17(4):833-842. doi:10.1111/j.1525-1438.2007.00895.x.
Fyles AW, Pintilie M, Kirkbride P, Levin W, Manchul LA, Rawlings GA. Prognostic factors in patients with cervix cancer treated by radiation therapy: results of a multiple regression analysis. Radiother Oncol. 1995;35(2):107-117. doi:10.1016/0167-8140(95)01535-o.
Perez CA, Grigsby PW, Chao KS, Mutch DG, Lockett MA. Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix. Int J Radiat Oncol Biol Phys. 1998;41(2):307-317. doi:10.1016/s0360-3016(98)00067-4.
Barillot I, Horiot JC, Pigneux J, Schraub S, Pourquier H, Daly N, et al. Carcinoma of the intact uterine cervix treated with radiotherapy alone: a French cooperative study: update and multivariate analysis of prognostics factors. Int J Radiat Oncol Biol Phys. 1997;38(5):969-978. doi:10.1016/s0360-3016(97)00145-4.
Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18(8):1606-1613. doi:10.1200/JCO.2000.18.8.1606.
Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340(15):1144-1153. doi:10.1056/NEJM199904153401502.
Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999;17(5):1339-1348. doi:10.1200/JCO.1999.17.5.1339.
Fyles A, Keane TJ, Barton M, Simm J. The effect of treatment duration in the local control of cervix cancer. Radiother Oncol. 1992;25(4):273-279. doi:10.1016/0167-8140(92)90247-r.
Girinsky T, Rey A, Roche B, Haie C, Gerbaulet A, Randrianarivello H, et al. Overall treatment time in advanced cervical carcinomas: a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys. 1993;27(5):1051-1056. doi:10.1016/0360-3016(93)90522-w.
Lanciano RM, Pajak TF, Martz K, Hanks GE. The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. Int J Radiat Oncol Biol Phys. 1993;25(3):391-397. doi:10.1016/0360-3016(93)90058-4.
Grigiene R, Valuckas KP, Aleknavicius E, Kurtinaitis J, Letautiene SR. The value of prognostic factors for uterine cervical cancer patients treated with irradiation alone. BMC Cancer. 2007;7:234. doi:10.1186/1471-2407-7-234.
Girinski T, Pejovic-Lenfant MH, Bourhis J, Campana F, Cosset JM, Petit C, et al. Prognostic value of hemoglobin concentrations and blood transfusions in advanced carcinoma of the cervix treated by radiation therapy: results of a retrospective study of 386 patients. Int J Radiat Oncol Biol Phys. 1989;16(1):37-42. doi:10.1016/0360-3016(89)90007-2.
Bush RS. The significance of anemia in clinical radiation therapy. Int J Radiat Oncol Biol Phys. 1986;12(11):2047-2050. doi:10.1016/0360-3016(86)90146-x.
Fu KK, Phillips TL. High-dose-rate versus low-dose-rate intracavitary brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 1990;19(3):791-796. doi:10.1016/0360-3016(90)90511-h.