eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2019
vol. 11
 
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abstract:
Original paper

Results from chemoradiotherapy for squamous cell cervical cancer with or without intracavitary brachytherapy

Diogo Delgado
1
,
André Figueiredo
1
,
Vera Mendonça
1
,
Marília Jorge
1
,
Miriam Abdulrehman
1
,
Maria Filomena de Pina
1

  1. Department of Radiation Oncology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
J Contemp Brachytherapy 2019; 11, 5: 417–422
DOI: https://doi.org/10.5114/jcb.2019.88116
Online publish date: 2019/09/19
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Purpose
The aim of this study is to compare the outcomes of intracavitary high-dose-rate brachytherapy (BT-IC) boost and external beam radiotherapy (EBRT) boost in patients treated with concomitant chemoradiotherapy for squamous cell carcinoma of the cervix.

Material and methods
It is a retrospective review of 92 patients with stage IB1-IVA cervical cancer treated with concomitant chemoradiotherapy between 2008 and 2013. All patients received pelvic 3D conformal EBRT (range, 45-50.4 Gy) concomitant with weekly cisplatin (40 mg/m2), and a BT-IC boost (37 patients: 4 fractions of 6 Gy prescribed to a point A) to the tumor or a 3D conformal EBRT boost (55 patients: 16.2 Gy), if the former was not technically feasible.

Results
The 5-year overall survival and recurrence-free survival rates for both groups were 68% and 55%, respectively. The 5-year overall survival and recurrence-free survival were better and statistically significant in the BT-IC group with 82% and 79%, respectively, as compared to the EBRT group with 58% and 38%, respectively. In multivariate analysis controlling for maximum tumor dimension, lymph node status, and FIGO stage, EBRT boost was associated with a statistical significant increase in the risk of recurrence (HR: 3.56; 95% CI: 1.27-10.02; p = 0.016) and a trend towards an increase in the risk of death (HR: 3.14; 95% CI: 0.97-10.17; p = 0.056). Lymph node status was also significantly associated with a greater risk of recurrence.

Conclusions
BT-IC boost was associated with a lower recurrence rate and better overall survival and recurrence-free survival. EBRT boost patients had a three-fold increase in the risk of recurrence. Brachytherapy is essential in the treatment of cervical cancer and improved alternatives are needed for patients who are not candidates for standard brachytherapy applicators.

keywords:

high-dose-rate brachytherapy, cervical cancer, gynecological cancer, radiotherapy

  
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