eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2020
vol. 12
 
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abstract:
Case report

High-dose-rate interstitial brachytherapy with hypoxic radiosensitizer KORTUC II for unresectable pelvic sidewall recurrence of uterine cervical cancer: a case report

Mio Nakata
1
,
Ken Yoshida
2
,
Taiju Shimbo
1
,
Nobuhiko Yoshikawa
1
,
Hiroto Yoshioka
1
,
Akihiro Hori
1
,
Chikara Sato
1
,
Yasuo Uesugi
3
,
Yuhei Kogata
4
,
Koji Masui
5
,
Naoya Murakami
6
,
Tairo Kashihara
6
,
Hironori Akiyama
7
,
Nikolaos Tselis
8
,
Masahide Ohmichi
4
,
Keiji Nihei
1

  1. Department of Radiation Oncology, Osaka Medical College, Japan
  2. Department of Radiology, Kansai Medical University Medical Center, Japan
  3. Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
  4. Department of Obstetrics and Gynecology, Osaka Medical College, Japan
  5. Department of Radiology, Kyoto Prefectural University of Medicine, Japan
  6. Department of Radiation Oncology, National Cancer Center Hospital, Japan
  7. Department of Oral Radiology, Osaka Dental University, Japan
  8. Department of Radiation Oncology, Johann Wolfgang Goethe University Frankfurt, Germany
J Contemp Brachytherapy 2020; 12, 6: 606–611
DOI: https://doi.org/10.5114/jcb.2020.101695
Online publish date: 2020/12/18
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In order to improve oncologic outcomes in radiotherapy treatments of patients with unresectable pelvic sidewall recurrences of uterine cervical cancer, we combined high-dose-rate interstitial brachytherapy (HDR-ISBT) with newly tested hypoxic radiosensitizer Kochi oxydol-radiation therapy for unresectable carcinomas (KORTUC II), an enzyme-targeting radiosensitization treatment involving intra-tumoral injection of sodium hyaluronate mixed with hydrogen peroxide. We report on a 63-year-old patient referred to our department with an extensive pelvic sidewall recurrence of uterine cervical cancer after initial hysterectomy. The tumor size was 55 × 25 × 80 mm, with a calculated volume of 89.7 cc. Whole pelvic irradiation of 50 Gy in 25 fractions was administered, combined with weekly cisplatin injections. KORTUC II injections were given two times: at day 21 (42 Gy) and at day 24 (48 Gy). After finishing whole pelvic irradiation, HDR-ISBT of 25 Gy in 5 fractions b.i.d. over 3 days was administered. KORTUC II was also injected at the time of implantation. Dose-volume histogram (DVH) values for clinical target volume were D90, D98, and D100 of 6.0, 5.0, and 3.5 Gy per fraction, respectively. D2cc values were 2.1, 4.1, 3.2, and 2.0 Gy per fraction for the bladder, rectum, sigmoid colon, and small bowel, respectively. No acute adverse events ≥ grade 3 were observed. Repeated grade 3 pyelonephritis occurred as a late complication at 11, 24, and 26 months after the treatment, and was successfully resolved with antibiotics. Moreover, grade 2 late toxicity was documented, including sciatic neuralgia, lower limb lymphedema, and urinary incontinence. At present, 32 months after HDR-ISBT, the patient remains free of disease, with no toxicity-related deterioration in physical condition.
keywords:

pelvic sidewall recurrence, uterine cervical cancer, high-dose-rate, interstitial brachytherapy, KORTUC

  
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