CARCINOMA OF THE CERVIX - ANALYSIS OF COMPLICATIONS AFTER PRIMARY EXTERNAL-BEAM RADIATION AND IR-192 HDR BRACHYTHERAPY

Background and purpose: There is still a concern that the use of HDR b rachytherapy might result in an increase of late tissue damage. This r etrospective study evaluates the incidence and severity of late compli cations in patients with carcinoma of the cervix who underwent combine d external beam radiation (EER) and Ir-192 HDR brachytherapy and attem pts to identify pretreatment and treatment parameters correlating with late complications. Material and methods: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB-IVB) received EE R to the pelvis (ave. max. dose 48.8 Gy) followed by 1-6 Ir-192 HDR pl acements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (medi an 17 Gy). Parameters examined included age, diabetes, obesity, histor y of inflammatory bowel disease or diverticulitis, prior surgery, hemo globin level, FIGO stage, EER dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to p oint A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the Fren ch-Italian Glossary (FIG). Results: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 16 1 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5% , 3.7%). Since some patients experienced more than one complication, t he overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respect ive 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% f or severe bowel and genitourinary tract complications (FIG: 3.5%, 0, a nd 2%, 8%). All severe bowel complications occurred within 1.5 years w hereas urinary tract sequelae continued to develop throughout the foll ow-up period. FIGO stage was associated with a significant increase in late sequelae (P = 0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant c orrelation with moderate or severe sequelae. Conclusion: In our series using HDR brachytherapy, complication and survival rates were compara ble with other series employing either LDR or HDR procedures. Of all p arameters analysed, stage of disease was the only parameter significan tly correlated with complications in univariate and multivariate analy sis. (C) 1997 Elsevier Science Ireland Ltd.