MULTIFRACTIONATED HIGH-DOSE-RATE BRACHYTHERAPY WITH CONCOMITANT DAILYTELETHERAPY FOR CERVICAL-CANCER

Background: High-dose-rate (HDR) brachy therapy has been the preferred treatment for cervical cancer at Wayne State University since 1987. T he outcome of the first 105 patients treated is analyzed. Purpose: To determine clinical efficacy of the HDR modality. Methods: We reviewed 105 patients and evaluated the 88 patients treated for cervical carcin oma with HDR and external beam radiotherapy (EBRT) from August 1987 to December 1992. Patients received initial external radiation to the pe lvis (total dose of 19.8 to 39.6 Gy in 11 to 22 fractions), followed b y outpatient HDR brachytherapy (3 fractions/week, 386 cGy/fraction to Point A, total of 8 to 12 fractions) and concurrent daily EBRT (1.8 to 2.0 Gy) to lateral parametria During the HDR period of treatment, ste p wedge transmission blocks were used to shield central pelvic tissue while treating peripheral pelvic tissues with EBRT. Patient distributi ons were as follows: 25, IB/IIA; 35, IIB/IIIA; and 28, IIIB/IVA. There were 56 African American and 32 Caucasian patients with mean age of 5 5 (range 19-89). The median followup was 33 months (range 20 to 76 mon ths). Kaplan-Meier analysis was performed. Results: Three-year surviva l rates were 88%, IB/IIA; 69%, IIB/IIIA; 56%, IIIB/IVA; and 72% overal l. Local control was achieved in 71/88 (80%) of patients. Failure site was cervix or within the pelvis in 12 patients, distant metastasis on ly 17 patients, and combined local and distant in 5 patients. Of the f ailures, 82% (28/34) died within 2 years. There were 3 grade III/IV co mplications (3.4%). Conclusion: Results compare favorably with previou s LDR experience. (C) 1996 Academic Press, Inc.