Ultrasound guided conformal brachytherapy of cervix cancer: survival, patterns of failure, and late complications

Abstract

ObjectiveThe aim of this study was to report on the long-term results of transabdominal ultrasound guided conformal brachytherapy in patients with cervical cancer with respect to patterns of failures, treatment related toxicities and survival.MethodsThree hundred and nine patients with cervical cancer who presented to Institute between January 1999 and December 2008 were staged with magnetic resonance imaging and positron emission tomography and treated with external beam radiotherapy and high dose rate conformal image guided brachytherapy with curative intent. Follow-up data relating to sites of failure and toxicity was recorded prospectively.ResultsTwo hundred and ninety-two patients were available for analyses. The median (interquantile range) follow-up time was 4.1 years (range, 2.4 to 6.1 years). Five-year failure free survival and overall survival (OS) were 66% and 65%, respectively. Primary, pelvic, para-aortic, and distant failure were observed in 12.5%, 16.4%, 22%, and 23% of patients, respectively. In multivariate analysis, tumor volume and nodal disease related to survival, whereas local disease control and point A dose did not.ConclusionUltrasound guided conformal brachytherapy of cervix cancer has led to optimal local control and OS. The Melbourne protocol compares favorably to the more technically elaborate and expensive GEC-ESTRO recommendations. The Melbourne protocol's technical simplicity with real-time imaging and treatment planning makes this a method of choice for treating patients with cervical cancer.

MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience

“…Presently, most series are limited to small numbers of patients and use of variable imaging techniques (Table 4). Outcomes appear exceptionally favorable using IBBT, with local control ranging from 78.5% to 100.0% (10,(14)(15)(16)(17)(18)(23)(24)(25). Our study adds to the IBBT body of literature by providing the largest North American experience and one of the largest series using MRI-based planning, showing similarly excellent local control rates (91.6%) and low rates of late grade 3 or greater toxicity (0.9%).…”

Two-year results of transabdominal ultrasound-guided brachytherapy for cervical cancer

“…The latest report by Narayan et al (25) also showed promising clinical results. Three hundred nine patients with cervical cancer were treated between January 1999 and December 2008 with external beam radiotherapy and HDR conformal TAUS-guided BT with curative intent.…”

“…Local failure rates according to FIGO Stage I, II, and III were 12%, 10%, and 17%, respectively. In toxicity profiles, the rate of Grade 3e4 toxicities of bladder, rectum, and vagina was 0.3, 0.99, and 0.69 per 100 person-years of FU, respectively (25).…”

Ultrasound Image Based High Dose Rate (HDR) Brachytherapy in Locally Advanced Cancer Cervix

“…All had used MRI based conformal brachytherapy using GEC-ESTRO recommendation. Kailash Narayan et al (15) concluded that real-time imaging and treatment planning using USG would make this a method of choice for treating cancer cervix in most parts of the world where cancer cervix remains a major health problem and MRI is inaccessible.…”