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Long term results of definitive radiotherapy for cervical carcinoma using four applications of high dose rate afterloading
Author(s) -
Busch Martin,
Meden Harald,
Meibodi Fattahi,
Dühmke Eckhart,
Kuhn Walther
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19991015)86:8<1520::aid-cncr19>3.0.co;2-c
Subject(s) - medicine , radiation therapy , brachytherapy , external beam radiotherapy , cervical cancer , survival rate , cancer , carcinoma , multivariate analysis , surgery , oncology , radiology , nuclear medicine
BACKGROUND In definitive radiotherapy for cervical carcinoma, combined modality treatment using external beam radiotherapy and brachytherapy is standard. Although the optimal number of afterloading applications is controversial, the majority of authors recommend three applications. METHODS In this study, the authors investigated the use of 4 applications with iridium‐192 afterloading with a dose of 7.5 grays (Gy). Standardized radiotherapy doses were adapted to the individual tumor anatomy using a prospective schedule. RESULTS In the 73 study patients, actuarial and tumor‐related 5‐year survival rates by T classification were: T1b: 30% (100% cause specific survival); T2a: 55% (76% cause specific survival); T2b: 50% (60% cause specific survival); T3a: 50% (67% cause specific survival); T3b: 39% (50% cause specific survival); and T4a: 40% (40% cause specific survival). Morbidity, graded according to the National Cancer Institute's Common Toxicity Criteria (CTC) were low: CTC Grade 1: 7 patients (7.6%); CTC Grade 2: 7 patients (7.6%); CTC Grade 3: 1 patient (1.4%); and CTC Grade 4: 1 patient (1.4%). In a multivariate analysis, the T classification was the only significant independent prognostic factor for actuarial survival, tumor related (cause specific) survival, local tumor control and freedom of metastatic disease. The number of afterloading applications was an independent prognostic factor for local tumor control. CONCLUSIONS Based on the long term results of the current study, external beam radiotherapy combined with 4 afterloading high dose rate applications (total of 30 Gy) appears to be clinically feasible and results in satisfactory survival rates and few side effects. Cancer 1999;86:1520–7. © 1999 American Cancer Society.