RSNA 2003 Scientific Papers > Long-term Complications of Fractionated High Dose ...
  Scientific Papers
  SESSION: Radiation Oncology and Radiobiology (Gynecological Cancer)

Long-term Complications of Fractionated High Dose Rate Brachytherapy Boost for Advanced Cervical Cancer

  DATE: Monday, December 01 2003
  START TIME: 03:20 PM
  END TIME: 03:27 PM
  LOCATION: Room S403B
  CODE: E15-496

James Fugazzi MD, MPH
Detroit , MI
Sameer Keole MD
Rajiv Patel MD
Ihn Han MD, PhD
Ayman Saad MD
Simon Lo
et al

Uterine neoplasms, therapeutic radiology
Purpose/Objective: To determine the long-term, grade III or higher complications of fractionated high-dose rate (HDR) brachytherapy boost added to external beam radiation (EBRT) in the treatment of advanced cervical cancer. Materials/Methods: From 1988 until 2000, 249 patients with advanced cervical cancer were treated with EBRT and Ir-192 HDR brachytherapy, at 386 cGy per fraction, prescribed to point A (500 cGy low-dose rate equivalent). Using a ring-and-tandem applicator, a total of 8 to 12 insertions were administered, alternating daily with an EBRT sidewall boost (if necessary). The median dose to point A was 7980 cGy (range 5660 to 9040 cGy) and the median HDR dose was 3088 cGy (range 772 to 5018 cGy). The median age was 52 years (range 19 to 89 years). Thirty-seven percent were white and 63% were black. Histology was as follows: 84% squamous cell, 8% adenocarcinoma, 4% adenosquamous and 4% other. FIGO staging was as follows: 38% were IB, 7% were IIA, 34% were IIB, 1% were IIIA, 19% were IIIB and 1% were IVA. Overall, 10% (n=25) had an attempt at surgical resection. Results: With a median follow-up period for surviving patients of 46 months (range 4 to 157 months), 5.2% (n=13) experienced grade III or higher complications. Six involved one site (1 rectal, 1 sigmoid colon, 3 small bowel and 1 other site), 5 involved two sites and 2 involved three sites. Among those with three sites of involvement, one had a prior retroperitoneal lymph node dissection and one required a colostomy. Thirty-one percent (n=4) with and 37% (n=87) without complications received chemotherapy (p=NS). Fifteen percent (n=2) with and 37% (n=21) without complications received radiation to the peri-aortic lymph nodes (p=NS). The median HDR dose and the median point A dose was identical between groups. Overall survival between those with and without complications was 38% and 49%, respectively (p=0.15). On univariate analysis, no factor, including age, race, histology, stage, chemotherapy administration, point A dose or peri-aortic radiation was significantly associated with complication rate. Conclusions: Based upon this large retrospective review, the use of fractionated HDR brachytherapy boost for advanced cervical cancer is associated with a favorable complication rate. This series is comparable to other reports of HDR-related toxicity.
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