International Journal of Radiation Oncology*Biology*Physics
Clinical investigationCombination external beam radiotherapy and high-dose-rate intracavitary brachytherapy for uterine cervical cancer: Analysis of dose and fractionation schedule☆
Introduction
High-dose-rate intracavitary brachytherapy (HDR-ICBT) has been widely used in treatment of uterine cervical cancer in Asia and Europe 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Despite some criticism of HDR-ICBT (13), its application has been increasing in the United States 14, 15. However, a wide variation of dose and fractionation schedules exists for the combination of external beam radiotherapy (EBRT) and HDR-ICBT 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 16, 17, 18. An optimum treatment schedule has not yet been clearly determined.
In this paper, we retrospectively analyzed the dose–response relationship for local control and late complication for uterine cervical cancer patients treated with a combination of EBRT and HDR-ICBT. The aim of this study was to determine an appropriate dose and fractionation schedule for EBRT and HDR-ICBT in the treatment of uterine cervical cancer.
Section snippets
Patients
Three hundred and twelve patients with uterine cervical cancer had been treated with radiotherapy at the University of the Ryukyus Hospital between August 1994 and December 1999. From these, 71 patients treated postoperatively, 65 patients treated with chemotherapy, 53 patients treated with palliative intent (i.e., Stage IVB, recurrence), 15 patients without pretreatment MRI, 10 patients with adenocarcinoma, 6 patients who underwent external beam radiotherapy at other institutions, and 4
Results
Median follow-up time for all 88 patients was 48 months (range: 8–88 months), and 58 months (range: 27–88 months) for the surviving 65 patients. No patients were lost to follow-up.
Discussion
An appropriate dose and schedule of radiotherapy have been determined mainly on the bases of retrospective dose–response analyses of local control and late complications for several malignant tumors. Dose–response analysis on local control has usually been performed as a function of tumor size and total dose delivered (23). However, there are some difficulties in retrospective evaluation of these two factors for uterine cervical cancer. Table 7 shows the data from previously published
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This study was supported by Grants-in-Aid for Cancer Research No. 14–6 from the Ministry of Health and Welfare, Japan.