Utilization of an Applicator System Including a Tandem with Multi-Directional Interstitial Needle-Guide Ring and Perineal Template for High Dose Rate Brachytherapy Boost Treatments of Large-Volume Cervical Adenocarcinoma

Abstract

patients (81.5%) and adenocarcinoma in 5 (18.5%). The rates of metastasis-directed therapy after recurrence were 23.1% and 71.4% in Groups A and B, respectively. In Group A, radical hysterectomy was performed in 1 patient; lymphadenectomy for para-aortic region in 4; neck dissection in 1; and radiotherapy for the para-aortic region in 4, supraclavicular region in 3, axillary region in 1, and mediastinum region in 3. In Group B, radical hysterectomy was performed in 1 patient, pulmonary resection in 1, and radiotherapy for the para-aortic region in 1. The total dose of radiotherapy was determined by the site of recurrence (39.6e60 Gy). The 2-year overall survival rates after the first recurrence (OSr) were 82.5% and 31.2% for Groups A and B, respectively (p Z 0.001). The 2-year OSr for patients who underwent salvage local therapy was 74.1%, whereas that for patients who did not was 41.6% (p Z 0.03). Grade 3 toxicity related to salvage local therapy was observed in 1 patient. Conclusion: Patients with extrapelvic lymph node recurrence alone had favorable prognoses. Metastasis-directed therapy may contribute to such long-term survival with acceptable toxicities.