Transperineal high-dose-rate interstitial radiation therapy in the management of gynecologic malignancies

• Published in: Strahlentherapie und Onkologie 2003-11, Vol.179 (11), p.737-741
• Main Authors: ITAMI, Jun, HARA, Ryusuke, KOZUKA, Takuyou, YAMASHITA, Hideomi, NAKAJIMA, Kaori, SHIBATA, Kouji, ABE, Yoshihisa, FUSE, Masashi, ITO, Masashi
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - radiotherapy; Aged; Biological and medical sciences; Brachytherapy - adverse effects; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - radiotherapy; Carcinosarcoma - mortality; Carcinosarcoma - radiotherapy; Data Interpretation, Statistical; Female; Follow-Up Studies; Genital system. Mammary gland; Humans; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - radiotherapy; Ovarian Neoplasms - mortality; Ovarian Neoplasms - radiotherapy; Perineum; Radiation; Radiation therapy; Radiotherapy Dosage; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Survival Analysis; Time Factors; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - radiotherapy; Vaginal Neoplasms - mortality; Vaginal Neoplasms - radiotherapy
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-003-1069-1

High-dose-rate interstitial radiation therapy is a newly introduced modality, and its role in the management of gynecologic malignancies remains to be studied. Clinical experience in high-dose-rate interstitial radiation therapy was retrospectively investigated. Eight patients with primary and nine with recurrent gynecologic malignancies underwent high-dose-rate interstitial radiation therapy with/without external-beam irradiation. Fractional dose of the high-dose-rate interstitial radiation therapy ranged between 4 and 6 Gy with total doses of 15-54 Gy. Interstitial irradiation was performed twice daily with an interval of > 6 h. 2-year local control rate was 75% for primary treatment and 47% for treatment of recurrence (p = 0.46). Maximum tumor size had a statistically significant impact on local control (p < 0.002). Grade 2 and 4 late complications were seen in five patients, and the incidence was significantly higher in patients with a larger volume enclosed by the prescribed fractional dose of high-dose-rate interstitial radiation therapy. The incidence of grade 2 and 4 complications at 18 months was 78% and 0% with a volume > 100 cm(3) and < or = 100 cm(3), respectively (p < 0.04). Although high-dose-rate interstitial radiation therapy is a promising modality, it must be applied cautiously to patients with bulky tumors because of the high incidence of serious complications.