HIGH-DOSE-RATE INTRACAVITARY IRRADIATION USING LINEAR SOURCE ARRANGEMENT FOR STAGE-II AND STAGE-III SQUAMOUS-CELL CARCINOMA OF THE UTERINE CERVIX

Purpose: The purpose of this article is to evaluate fractionated high- dose-rate (HDR) intracavitary irradiation using linear source arrangem ent (LSA) for patients with squamous cell carcinoma of the uterine cer vix. Materials and methods: The subjects consisted of 217 patients (71 patients with stage II and 146 with stage III disease) who received e xternal beam therapy (EBT) followed by fractionated HDR intracavitary irradiation using LSA between January 1980 and June 1990. In EBT, 40 G y in 20 fractions (40 Gy/20 Fr) or 39.6 Gy/22 Pr was delivered to the whole pelvis and an additional 10 Gy/5 Fr or 10.8 Gy/6 Fr was delivere d to the parametrium. The intracavitary irradiation dose was 30 Gy/6 F r or 35 Gy/7 Fr with a daily fraction size of 5 Gy and two fractions p er week. During the intracavitary treatment, most patients were treate d on an out-patient basis. Results: Cause-specific 5-year survival rat es were 77% for stage II and 50% for stage m. Pelvic failure rates wer e 13% for stage II and 36% for stage III. In multivariate analyses, im proved cause-specific survival was significantly associated with stage II (P = 0.0003), higher pretreatment serum hemoglobin level (P = 0.00 15), higher pretreatment serum total protein level (P = 0.0029), and s horter total treatment time (P = 0.0024), The rate of severe (grade 3 or 4) late complication was 2% for the rectum, 1% for the small intest ine or sigmoid colon and 1% for the bladder. Conclusions: Fractionated HDR intracavitary irradiation using LSA is an effective treatment for patients with uterine cervical cancer without need for hospitalizatio n. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.