Outcomes with volume-based dose specification in CT-planned high-dose-rate brachytherapy for stage I-II cervical carcinoma: A 10-year institutional experience

• Published in: Gynecologic oncology 2016-12, Vol.143 (3), p.545-551
• Main Authors: Cho, Linda P., BA, Manuel, Matthias, MD, Catalano, Paul, ScD, Lee, Larissa, MD, Damato, Antonio L., PhD, Cormack, Robert A., PhD, Buzurovic, Ivan, PhD, Bhagwat, Mandar, PhD, O'Farrell, Desmond, MSc, Devlin, Phillip M., MD, Viswanathan, Akila N., MD, MPH
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brachytherapy; Brachytherapy - methods; Carcinoma, Adenosquamous - diagnostic imaging; Carcinoma, Adenosquamous - pathology; Carcinoma, Adenosquamous - radiotherapy; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Cervical cancer; Chemoradiotherapy; CT-guided; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; High-dose-rate; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Obstetrics and Gynecology; Prognostic factors; Radiation oncology; Radiotherapy Planning, Computer-Assisted - methods; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2016.09.017

Abstract Objective To determine prognostic factors for progression-free survival (PFS) and overall survival (OS) for stage I-II cervical-cancer patients treated using computed-tomography (CT)-planned high-dose-rate (HDR) intracavitary brachytherapy (BT). Methods A total of 150 patients were treated for Stage I-II cervical cancer using CT-planned BT between 4/2004 and 10/2014. Of these, 128 were eligible for inclusion. Kaplan-Meier local control (LC), pelvic control (PC), overall survival (OS), and PFS estimates were calculated. Results After a median follow-up of 30 months, the 2-year LC rate was 96%, PFS was 88%, and OS was 88%. Overall, 18 patients (14%) experienced any recurrence (AR), 8 had distant recurrence only and 10 had a combination of local, pelvic, regional, and distant recurrence. No patients had LR only. A prognostic factor for AR was tumor size > 4 cm ( p = 0.01). Patients with tumors > 4 cm were 3.3 times more likely to have AR than those with tumors ≤ 4 cm (hazard ratio [HR] = 3.3; 95% confidence interval [CI] 1.28–9.47). Point A was 85% of prescription for tumors < 4 cm and decreased approximately 3% over 5 fractions compared to 90% of prescription for tumors > 4 cm that decreased approximately 4% over 5 fractions. Two patients (2%) experienced grade ≥ 2 late toxicity. There were no acute or late grade ≥ 3 toxicities. Conclusion CT-planned BT resulted in excellent local control and survival. Large tumor size was associated with an increased risk of recurrence outside the radiation field and worse PFS and OS. A volume-optimized plan treated a smaller area than a point A standard plan for patients with Stage I-II cervical cancer that have received chemoradiation. Given the outstanding LC achieved with modern therapy including chemoradiation, HDR, and image-based BT, further efforts to combat spread outside the radiation field with novel therapies are warranted.