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. 2023 Dec;15(6):399-404.
doi: 10.5114/jcb.2023.134169. Epub 2023 Dec 29.

Clinical outcomes of single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy for locally advanced cervical cancer: A multi-institution initial experience

Eugene T Yap  1 , Mark P Dumago  1 , Carl Jay Jainar  1 , Maureen Bojador  1 , Stellar Marie Cabrera  1 , Gil S Gonzalez  2 , Jocelyn Z Mariano  2 , Aida Bautista  3 , Jhustine Mababangloob  4 , Janell Marie Genson  4 , Teresa Sy Ortin  1 , Warren R Bacorro  1
Affiliations

Clinical outcomes of single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy for locally advanced cervical cancer: A multi-institution initial experience

Eugene T Yap et al. J Contemp Brachytherapy. 2023 Dec.

Abstract

Purpose: The aim of the study was to evaluate the safety and clinical outcomes of single application multi-fractionated computed tomography (CT)-guided interstitial high-dose-rate brachytherapy given in four fractions in locally advanced cervical cancer.

Material and methods: Patients with locally advanced cervical cancer stage IIB-IVA treated definitively with external radiation ± weekly cisplatin, followed by single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy in four fractions were included. Dosimetry data, clinical response, and toxicity records were reviewed.

Results: Between January 2018 and December 2022, twenty-two patients were included. Clinical stage distribution was as follows: IIB - 13.6%, IIIB - 27.3%, IIIC - 22.7%, and IVA - 36.4%. Mean high-risk clinical target volume (HR-CTV) was 66.19 ±32.69 cm3, and HR-CTV D90 dose was 86.8 ±1.7 Gy. 2 cc doses to bladder, rectum, and sigmoid were 84.6 ±2.8 Gy, 71.5 ±2.4 Gy, and 65.6 ±4.0 Gy, respectively. Mean overall treatment time was 66 ±21 days. With a median follow-up of 11.5 months (range, 5-44 months), median survival and local control were not achieved. One-year local control rate, one-year progression-free survival, and one-year overall survival were 82%, 66%, and 78%, respectively. Univariate analysis showed overall treatment time to be the only variable associated with all oncologic outcomes. For acute toxicity, grade 3 toxicity in four patients and grade 4 toxicity of infection in one patient were observed. For late toxicity, grade 3 gastrointestinal toxicity was noted in two patients.

Conclusions: Initial results suggest that single application multi-fractionated CT-guided interstitial brachytherapy given in four fractions in locally advanced cervical cancer seems to be feasible and safe, but additional evidence is needed to generate more validated conclusions.

Keywords: CT-guided; cervical cancer; high-dose-rate; interstitial brachytherapy; single application.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Overall survival, Kaplan-Meier curve
Fig. 2
Fig. 2
Local control, Kaplan-Meier curve
Fig. 3
Fig. 3
Progression-free survival, Kaplan-Meier curve
See this image and copyright information in PMC

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