The Treatment Outcome of Cervix Cancer Treated with External Beam Radiotherapy, High-Dose-Rate Brachytherapy and Concurrent Chemotherapy

Purpose/Objective(s)To analyze the treatment outcome of cervix cancer treated with definitive concurrent radiochemotherapy and to evaluate the appropriacy of HDR brachytherapy fractionation of our institute.Materials/Methods64 patients with cervix cancer stage IB1-IIIB who were treated between 2001 and 2009 at our institute were included in this analysis. External beam radiotherapy was delivered to whole pelvis with dose of 41.4 - 50.4 Gy followed by midline block delivering total dose up to 50.4 - 59.4 Gy in 28 - 33 fractions. In patients with para-aortic nodal involvement, extended filed was used receiving 45 - 50.4 Gy. High-dose-rate intracavitary brachytherapy was performed twice a week with 192-Ir. The prescription dose was 24 - 32 Gy in 6 - 8 fractions to point A. In all patients, platinum-based chemotherapy was administered during the radiation therapy period except a day of brachytherapy.ResultsSeven patients had stage I disease (10.9%), 47 patients stage II (73.5%) and 10 patients stage III (15.6%). Median follow up was 40 months (range, 6.5 - 119.2 months). The actual delivered dose to point A was median 74 GyEQD2 with a/b ratio of 10 (range, 64 to 80 GyEQD2). Persistent disease was found in 1 patient and 3-year local control rate was 94.1%. 3-year rate of pelvic control and disease-free survival were 86.5% and 82.9%, respectively. Late rectal and urinary toxicities of Grade 2 were developed in 7 patients (10.9%) and 8 patients (12.5%), respectively. Only one patient experienced Grade 4 rectal toxicity and there was no Grade 3 - 4 late urinary toxicity.ConclusionsWe achieved good local and pelvic control comparable to historical data with a median radiation dose of 74 GyEQD2 to point A which is lower than the generally recommended dose of 85 - 90 GyEQD2. To confirm this result, longer follow up is needed. Purpose/Objective(s)To analyze the treatment outcome of cervix cancer treated with definitive concurrent radiochemotherapy and to evaluate the appropriacy of HDR brachytherapy fractionation of our institute. To analyze the treatment outcome of cervix cancer treated with definitive concurrent radiochemotherapy and to evaluate the appropriacy of HDR brachytherapy fractionation of our institute. Materials/Methods64 patients with cervix cancer stage IB1-IIIB who were treated between 2001 and 2009 at our institute were included in this analysis. External beam radiotherapy was delivered to whole pelvis with dose of 41.4 - 50.4 Gy followed by midline block delivering total dose up to 50.4 - 59.4 Gy in 28 - 33 fractions. In patients with para-aortic nodal involvement, extended filed was used receiving 45 - 50.4 Gy. High-dose-rate intracavitary brachytherapy was performed twice a week with 192-Ir. The prescription dose was 24 - 32 Gy in 6 - 8 fractions to point A. In all patients, platinum-based chemotherapy was administered during the radiation therapy period except a day of brachytherapy. 64 patients with cervix cancer stage IB1-IIIB who were treated between 2001 and 2009 at our institute were included in this analysis. External beam radiotherapy was delivered to whole pelvis with dose of 41.4 - 50.4 Gy followed by midline block delivering total dose up to 50.4 - 59.4 Gy in 28 - 33 fractions. In patients with para-aortic nodal involvement, extended filed was used receiving 45 - 50.4 Gy. High-dose-rate intracavitary brachytherapy was performed twice a week with 192-Ir. The prescription dose was 24 - 32 Gy in 6 - 8 fractions to point A. In all patients, platinum-based chemotherapy was administered during the radiation therapy period except a day of brachytherapy. ResultsSeven patients had stage I disease (10.9%), 47 patients stage II (73.5%) and 10 patients stage III (15.6%). Median follow up was 40 months (range, 6.5 - 119.2 months). The actual delivered dose to point A was median 74 GyEQD2 with a/b ratio of 10 (range, 64 to 80 GyEQD2). Persistent disease was found in 1 patient and 3-year local control rate was 94.1%. 3-year rate of pelvic control and disease-free survival were 86.5% and 82.9%, respectively. Late rectal and urinary toxicities of Grade 2 were developed in 7 patients (10.9%) and 8 patients (12.5%), respectively. Only one patient experienced Grade 4 rectal toxicity and there was no Grade 3 - 4 late urinary toxicity. Seven patients had stage I disease (10.9%), 47 patients stage II (73.5%) and 10 patients stage III (15.6%). Median follow up was 40 months (range, 6.5 - 119.2 months). The actual delivered dose to point A was median 74 GyEQD2 with a/b ratio of 10 (range, 64 to 80 GyEQD2). Persistent disease was found in 1 patient and 3-year local control rate was 94.1%. 3-year rate of pelvic control and disease-free survival were 86.5% and 82.9%, respectively. Late rectal and urinary toxicities of Grade 2 were developed in 7 patients (10.9%) and 8 patients (12.5%), respectively. Only one patient experienced Grade 4 rectal toxicity and there was no Grade 3 - 4 late urinary toxicity. ConclusionsWe achieved good local and pelvic control comparable to historical data with a median radiation dose of 74 GyEQD2 to point A which is lower than the generally recommended dose of 85 - 90 GyEQD2. To confirm this result, longer follow up is needed. We achieved good local and pelvic control comparable to historical data with a median radiation dose of 74 GyEQD2 to point A which is lower than the generally recommended dose of 85 - 90 GyEQD2. To confirm this result, longer follow up is needed.