Medium-dose-rate brachytherapy of cancer of the cervix: Preliminary results of a prospectively designed schedule based on the linear-quadratic model

Purpose: To compare results and complications of our previous low-dose-rate (LDR) brachytherapy schedule for early-stage cancer of the cervix, with a prospectively designed medium-dose-rate (MDR) schedule, based on the linear-quadratic model (LQ). Methods and Materials: A combination of brachytherapy, external beam pelvic and parametrial irradiation was used in 102 consecutive Stage Ib-IIb LDR treated patients (1986-1990) and 42 equally staged MDR treated patients (1994-1996). The planned MDR schedule consisted of three insertions on three treatment days with six 8-Gy brachytherapy fractions to Point A, two on each treatment day with an interfraction interval of 6 hours, plus 18 Gy external whole pelvic dose, and followed by additional parametrial irradiation. The calculated biologically effective dose (BED) for tumor was 90 Gy(10) and for rectum below 125 Gy(3). Results: In practice the MDR brachytherapy schedule achieved a tumor BED of 86 Gy(10) and a rectal BED of 101 Gy(3). The latter was better than originally planned due to a reduction from 85% to 77% in the percentage of the mean dose to the rectum in relation to Point A. The mean overall treatment time was 10 days shorter for MDR in comparison with LDR. The 3-year actuarial central control for LDR and MDR was 97% and 98% (p = NS), respectively. The Grades 2 and 3 late complications (scale 0 to 3) were 1% and 2.4%, respectively for LDR (3-year) and MDR (2-year). Conclusions: LQ is a reliable tool for designing new schedules with altered fractionation and dose rates. The MDR schedule has proven to be an equivalent treatment schedule compared with LDR, with an additional advantage of having a shorter overall treatment time. The mean rectal BED Gy, was lower than expected. (C) 1999 Elsevier Science Inc.