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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2023
vol. 15
 
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abstract:
Original paper

Clinical outcomes of single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy for locally advanced cervical cancer: A multi-institution initial experience

Eugene T Yap
1
,
Mark P Dumago
1
,
Carl Jay Jainar
1
,
Maureen Bojador
1
,
Stellar Marie Cabrera
1
,
Gil S Gonzalez
2
,
Jocelyn Z Mariano
2
,
Aida Bautista
3
,
Jhustine Mababangloob
4
,
Janell Marie Genson
4
,
Teresa Sy Ortin
1
,
Warren R Bacorro
1

  1. Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Philippines
  2. Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Philippines
  3. Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Manila Doctors Hospital, Philippines
  4. Department of Radiation Oncology, Manila Doctors Hospital, Philippines
J Contemp Brachytherapy 2023; 15, 6: 399–404
DOI: https://doi.org/10.5114/jcb.2023.134169
Online publish date: 2023/12/29
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Purpose:
The aim of the study was to evaluate the safety and clinical outcomes of single application multi-fractionated computed tomography (CT)-guided interstitial high-dose-rate brachytherapy given in four fractions in locally advanced cervical cancer.

Material and methods:
Patients with locally advanced cervical cancer stage IIB-IVA treated definitively with external radiation ± weekly cisplatin, followed by single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy in four fractions were included. Dosimetry data, clinical response, and toxicity records were reviewed.

Results:
Between January 2018 and December 2022, twenty-two patients were included. Clinical stage distribution was as follows: IIB – 13.6%, IIIB – 27.3%, IIIC – 22.7%, and IVA – 36.4%. Mean high-risk clinical target volume (HR-CTV) was 66.19 ±32.69 cm3, and HR-CTV D90 dose was 86.8 ±1.7 Gy. 2 cc doses to bladder, rectum, and sigmoid were 84.6 ±2.8 Gy, 71.5 ±2.4 Gy, and 65.6 ±4.0 Gy, respectively. Mean overall treatment time was 66 ±21 days. With a median follow-up of 11.5 months (range, 5-44 months), median survival and local control were not achieved. One-year local control rate, one-year progression-free survival, and one-year overall survival were 82%, 66%, and 78%, respectively. Univariate analysis showed overall treatment time to be the only variable associated with all oncologic outcomes. For acute toxicity, grade 3 toxicity in four patients and grade 4 toxicity of infection in one patient were observed. For late toxicity, grade 3 gastrointestinal toxicity was noted in two patients.

Conclusions:
Initial results suggest that single application multi-fractionated CT-guided interstitial brachytherapy given in four fractions in locally advanced cervical cancer seems to be feasible and safe, but additional evidence is needed to generate more validated conclusions.

keywords:

cervical cancer, interstitial brachytherapy, high-dose-rate, CT-guided, single application

  
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