A comparison of external pelvic chemoradiation and high dose-rate conventional brachytherapy (BT) and image-guided adaptive brachytherapy (IGABT) in treatment of advanced cervical carcinomas

Purpose: External pelvic chemo-radiotherapy and brachytherapy were studied in a consecutive series of advanced cervical carcinomas. Conventional brachytherapy and image-guided adaptive brachytherapy were compared. Material and Methods: From a single regional cancer center 272 consecutive patients with advanced cervical cancer were recruited. One hundred thirty-four patients were treated with external beam radiotherapy and conventional conformal brachytherapy (BT) and 138 patients with image-guided adaptive brachytherapy (IGABT). A comprehensive dosimetric study was performed in the IGABT-group. Predictive and prognostic factors were defined. Toxicity of the organs at risk were evaluated by the CTCAE-grading system. Results: The mean follow-up was 59 months. Tumor size was in mean 43 mm. The mean external dose was 52 Gy and the total dose to the clinical target volume was 78 Gy. Sixty-five percent of the patients received weekly cisplatin. The mean overall treatment time was 44 days. The median number of brachytherapy fractions was four and in 86 patients in the IGABT-group interstitial needles were applied. The primary local control was 98%. The overall pelvic control was 86%. The overall recurrence rate was 29%. The overall 5-year survival rate was 65% and cancer-specific survival rate 69%. Prognostic factors were FIGO-stage, pelvic and distant control of the disease. Late serious toxicity of the bladder and intestine were rare with only 3% in the IGABT-group. Conclusion: The local and pelvic controls were excellent. The IGABT was an important part of the treatment schedule with regard to large tumors and adenocarcinomas. Late toxicity was significantly lower after treatment with IGABT compared with BT.