High dose rate transperineal interstitial brachytherapy for cervical cancer: High pelvic control and low complication rates

Purpose: To report the clinical outcome for cervical carcinoma treated with external beam pelvic radiotherapy and interstitial high dose rate (IS-HDR) brachytherapy. Methods and Materials: Between July 1991 and June 1996, 62 patients with locally advanced stage cervical carcinoma or early stage carcinoma that precluded satisfactory tandem and ovoid insertion were treated. Most patients received 36 GS' (range: 25 Gy-45 Gy) external beam radiotherapy (EBRT) to the pelvis prior to brachytherapy implant. EBRT was continued, with central shielding, to a dose of 50 Gy to the pelvic sidewalls. HDR Iridium-192 brachgtherapy was given in 6 fractions of 5.5 to 6.0 Gy, The mean follow-up was 40 months. Results: Stage distribution was: Stage IB (12), Stage IIA (1), Stage IIB (26), Stage IIIA (6), Stage IIIB (13), and Stage IV4 (4), The overall local tumor control was 94%. Local control rates by FIGO stage were Stage 1(12/12) 100%, Stage II (25/27) 93%, Stage III (18/19) 95%, and Stage IV (3/4) 75%. The regional pelvic control rates were overall 81%, Stage 1(12/12) 100%, Stage II (22/27) 81%, Stage III (15/19) 79%, and Stage IV (1/4) 25%. Distant metastasis developed in 20 patients (32%). The actuarial 5-year disease-free survival was for all patients 48%? Stage I 81%, Stage LI 47%, Stage III 39%, and Stage IV O%. Grade 3-4 delayed morbidity resulting from treatment, occurred in 6.5%? (4/62) of patients. A fistula without local recurrence occurred in 1.6% (1/62) patients. Conclusions: We report excellent local and regional pelvic control results using a 6 fraction IS-HDR brachytherapy protocol for cervical carcinoma. The incidence of severe complications is low and suggests that a consistent brachytherapy technique and multiple HDR fractions are therapeutically advantageous to patients treated for cervical carcinoma, (C) 1999 Elsevier Science Inc.