Concomitant chemoradiotherapy with high dose rate brachytherapy as a definitive treatment modality for locally advanced cervical cancer
Purpose: This study aims to report the incidence of treatment-induced acute toxicities, local control and survival of patients with cervix cancer treated by external beam radiotherapy (EBR) and high-dose-rate (HDR) brachytherapy concomitant with weekly Cisplatin chemotherapy.
Methods: Forty patients with FIGO Stages IB2 and II were treated. The mean age was 48.49 years. EBR to the whole pelvis TO 45 Gy in 25 fractions was given to all patients. Aparametrial boost was given in 60% of patients, to a median dose of 9 Gy. Brachytherapy with HDR was performed during or after completing EBR with a dose of 24 Gy in four fractions of 6 Gy delivered weekly to point ‘‘A’’ or in some patients who were planned on MRI image guided brachytherapy with dose prescribed to high risk clinical target volume (CTV). Patient age, tumor stage, and presence or
absence of comorbid conditions as diabetes mellitus, ischemic vascular disease and collagen disease and total dose to right and left point ‘‘A’’ were variables analyzed for treatment induced toxicities, survival and local control. Cumulative biologic effective dose (BED) at rectal and bladder reference points were correlated with treatment complications in these organs.
Results: The most common acute toxicities included grade 1 and 2 fatigue (30%), diarrhea (25%), decreased neutrophil count (25%) and anemia (22.5%). Only 5% of the patients developed grade 3 rectal complications (proctitis and rectal bleeding) and 10% developed grade 1 or 2 rectal complications. Regarding urinary complications, 12.5% developed grade 1 or 2 toxicities. Mean follow-up time was 20 months. Overall survival, disease-free survival, and local control were 100%, 92.5 %, and 95%, respectively. One patient developed bone metastases and two patients developed local relapse.
Conclusion: This study suggests that concomitant chemoradiotherapy with 45 Gy to the whole pelvis concomitant with cisplatin chemotherapy and four fractions of 6 Gy to point ‘‘A’’ with HDR brachytherapy is an effective and tolerable fractionation schedule in the treatment of Stages IB2 and II cervix cancer.