Comparison of low and high dose rate brachytherapy in the treatment of uterine cervix cancer. Retrospective analysis of two sequential series |
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| Authors: | Ferrigno Robson Nishimoto Ines Nobuko Novaes Paulo Eduardo Ribeiro dos Santos Pellizzon Antonio Cássio Assis Maia Maria Aparecida Conte Fogarolli Ricardo César Salvajoli João Victor |
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| Institution: | 2. Department of Radiation Oncology, Hospital do Câncer A. C. Camargo, São Paulo, Brazil;3. Department of Biostatistics, Hospital do Câncer A. C. Camargo, São Paulo, Brazil;1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States;2. Comprehensive Cancer Center. University of Alabama at Birmingham, Birmingham AL, United States;3. University of Northern Colorado Cancer Rehabilitation Institute, Greeley, CO, United States;4. School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, United States;1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. School of Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;1. Danish Cancer Society, Strandboulevarden 49, DK 2100 Copenhagen, Denmark;2. Danish Cancer Society, Department of Documentation & Quality, Strandboulevarden 49, Copenhagen, Denmark;3. Krebsregister Schleswig-Holstein, Institut für Krebsepidemiologie, Universität zu Lübeck, Ratzeburger Allee 160, Haus 50, 23538 Lübeck, Germany;4. Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, Zentralklinikum (Haus 40), 23538 Lübeck, Germany;5. Department of Oncology and Haematology, Region Sjælland, Sygehus Syd Næstved, Ringstedgade 61, 4700 Næstved, Denmark;1. Department of Surgery, Mayo Clinic, Rochester, Minnesota;1. Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota;2. Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York;1. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia;2. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina;3. Department of Biostatistics, Carolinas HealthCare System, Charlotte, North Carolina;5. Department of Oncology, Carolinas HealthCare System, Charlotte, North Carolina;4. Southeast Radiation Oncology Group, Charlotte, North Carolina;6. Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina |
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| Abstract: | PURPOSE: This retrospective analysis aims to report on the comparative outcome of cervical cancer patients treated with low dose rate (LDR) and high dose rate (HDR) brachytherapy. METHODS AND MATERIALS: From 1989 to 1995, 190 patients were treated with low dose rate (LDR) brachytherapy (LDR group) and from 1994 to 2001, 118 patients were treated with high dose rate (HDR) brachytherapy (HDR group). FIGO stage distribution for the LDR group was Stage I: 6.3%; Stage II: 57.4%; and Stage III: 36.3% and for the HDR group Stage I: 9.3%; Stage II: 43.2%; and Stage III: 47.4%. All patients were treated with telecobalt external-beam radiotherapy (EBR). Median doses of LDR brachytherapy at Point A were 40 Gy and 50 Gy for patients treated with 1 and 2 implants, respectively. All patients from the HDR group were treated with 24 Gy in 4 fractions of 6 Gy to Point A. Survival, disease-free survival, local control, and late complications at 5 years, were endpoints compared for both groups. RESULTS: Median follow-up time for LDR and HDR groups was 70 months (range, 8-127 months) and 33 months (range, 4-117 months), respectively. For all stages combined, overall survival, disease-free survival, and local control at 5 years were better in the LDR group (69% vs. 55%, p = 0.007; 73% vs. 56%, p = 0.002; and 74% vs. 65%; p = 0.04, respectively). For clinical Stages I and II, no differences was seen in overall survival, disease-free survival, and local control at 5 years between the two groups. For clinical Stage III, overall survival and disease-free survival at 5 years were better in the LDR group than in the HDR group (46% vs. 36%, p = 0.04 and 49% vs. 37%, p = 0.03, respectively), and local control was marginally higher in the LDR group than in the HDR group (58% vs. 50%, p = 0.19). The 5-year probability of rectal complications was higher in the LDR group than in the HDR group (16% vs. 8%, p = 0.03) and 5-year probability of small bowel and urinary complications was not statistically different between the the LDR group and the HDR group (4.6% vs. 8.9%, p = 0.17 and 6% vs. 3%, p = 0.13, respectively). CONCLUSIONS: This comparative series suggests similar outcome for Stages I and II patients treated with either HDR or LDR brachytherapy. Lower overall and disease-free survival and marginally lower local control were observed for Stage III patients treated with HDR brachytherapy. Less late rectal complications were observed in the HDR group patients. These findings were probably the result of the relatively low HDR brachytherapy dose delivered at Point A. |
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