15019 Background: The purpose of this study was to assess the effectiveness of concurrent chemoradiotherapy (CCRT) using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a dose schedule modified from the American Brachytherapy Society (ABS) recommendation. Methods: 68 consecutive patients (IB2: 3, IIA: 2, IIB: 32, and IIIB: 31) with cervical squamous cell carcinoma consecutively treated with CCRT using HDR-ICBT were retrospectively analyzed. Patients with para-aortic lymphadenopathy (greater than 10mm in minimum diameter assessed by CT) were excluded. The median tumor size (assessed by MRI) was 60mm (range: 40–86mm). Cisplatin (20 mg/m2/day) was concurrently administered with radiotherapy (RT) for 5 days at 21-day intervals for a median of 2 courses (range: 1–5). The planned RT schedule consisted of pelvic external beam RT (EBRT) with 40Gy/20 fractions followed by HDR-ICBT with 18Gy/3 fractions and pelvic EBRT with 10Gy/5 fractions using a midline block (MB). The cumulative biologically effective dose (BED) at point A of this schedule was 77Gy10. 60 patients (88%) were treated with this schedule. In the remaining 8 patients, pelvic EBRT was delivered without MB (up to 50Gy), and/or additional HDR-ICBT (up to 24Gy) was given. The actual BED for all 68 patients thus ranged from 77 to 89 Gy10. Median follow-up of the surviving 54 patients was 46 months (range: 8–91 months). Late complications were graded by the RTOG/EORTC criteria. Results: The actuarial overall survival rate, disease-free survival rate, and pelvic control rate at 4 years were 78% (95% CI, 68–90%), 74% (95% CI, 63–85%), and 90% (95% CI, 83–97%), respectively. Only one patient suffered a grade 3 complication (enterocolitis). The actuarial late complication (Grade 1or higher) rates at 4 years were 12% (95% CI, 3–20%) for proctitis, 2% (95% CI, 0–5%) for cystitis, and 21% (95% CI, 10–33%) for enterocolitis. Conclusions: This retrospective analysis suggests that CCRT using HDR-ICBT with a modified dose schedule was able to achieve favorable pelvic disease control without severe late complications for patients with cervical cancer. No significant financial relationships to disclose.
Comparison of concurrent chemoradiotherapy followed by radical surgery and high-dose-rate intracavitary brachytherapy: a retrospective study of 240 patients with FIGO stage IIB cervical carcinoma