Brachytherapy for stage IIIB squamous cell carcinoma of the uterine cervix: survival and toxicity

Abstract

SummaryObjective. To compare survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate (LDR), high-dose-rate (HDR) brachytherapy and association of HDR and chemotherapy. MethOds. Between 1985 and 2005, 230 patients with FIGO stage IIIB squamous cell carcinoma of the uterine cervix received 4-field pelvic teletherapy at doses between 40 and 50.4 Gy, with a different complementation in each group. The LDRB group, with 42 patients, received one or two insertions of LDR, with Cesium-137, in a total dose of 80 to 100Gy at point A. The HDR group, 155 patients received HDR in 4 weekly 7 Gy fractions and 9 Gy to 14.4 Gy applied to the involved parametria. The CHT group, 33 patients, were given the same treatment as the HDR group and received 5 or 6 weekly cycles of cisplatin, 40 mg per m2. Results. The five-year progression-free survival (PFS) was 60% for the HDR group and 45% for the LDR group, and the two-year PFS for the CHT group was 65% (p = 0.02). The five-year Overall Survival (OS) was 65% for the HDR group and 49% for the LDR group. The two-year OS was 86% for the CHT group (p = 0.02). Rectum toxicity grade II was 7% for the LDR group, 4% for the HDR group and 7% for the CHT group that had one case of rectum toxicity grade IV. cOnclusiOn. Patients that received HDR had better OS and PFS. The Chemotherapy-HDR association showed no benefit when compared to HDR only. Toxicity rates showed no difference between the three groups.

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

“…For those patients, the weighted mean PC at ≥24 months for RT: 74%, SD: 11 (95% CI: 52, 95) and CRT: 81%, SD: 9 (95% CI: 64, 99). For the 51 retrospective studies reviewed that met our criteria, 28 studies reported PC outcomes for radiation and 28 for chemoRT with HDR BT (42–92). The weighted mean PC rate at ≥24 months for RT was 75%, SD: 18 (95% CI: 40, 110) and for CRT was 81%, SD: 16 (95% CI: 49, 112).…”

Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries

“…Only one reported the use of three-dimensional brachytherapy in a few patients. Brachytherapy was the main focus in a study from Venezuela, which evaluated 18 Gy/2 fractions, and another from Brazil, where chemoradiation with HDR for stage IIIB cancers was analysed [43,44].…”

An overview of recently published medical papers in Brazilian scientific journals

“…And conclude that clinical staging presents limited efficacy for the correct staging of non-small cell lung cancer patients in a sample of the Brazilian population. Zuliani et al47 compared survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate, high-dose-rate, brachytherapy and association of high-dose-rate and chemotherapy. They find that patients receiving high-dose-rate had better survival.…”