The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix

Purpose: This report presents guidelines for using high-dose-rate (HDR) bra chytherapy in the management of patients with cervical cancer, taking into consideration the current availability of resources in most institutions. Methods: Members of the American Brachytherapy Society (ABS) with expertise in RDR brachytherapy for cervical cancer performed a literature review, su pplemented their clinical experience to formulate guidelines for HDR brachy therapy of cervical cancer. Results: The ABS strongly recommends that definitive: irradiation for cervi cal carcinoma must include brachytherapy as a component. Each institution s hould follow a consistent treatment policy when performing HDR brachytherap y, including complete documentation of treatment parameters and correlation with clinical outcome, such as pelvic control, survival, and complications . The goals are to treat Point A to at least a total low-dose-rate (LDR) eq uivalent of 80-85 Gy for early stage disease and 85-90 Gy for advanced stag e. The pelvic sidewall dose recommendations are 50-55 Gy for early lesions and 55-65 Gy for advanced ones. The relative doses given by external beam r adiation therapy (EBRT) vs. brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tum or regression during pelvic irradiation, and institutional preference. As w ith LDR brachytherapy, every attempt should be made to keep the bladder and rectal doses below 80 Gy and 75 Gy LDR equivalent doses, respectively. Int erstitial brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary brachytherapy. While reco gnizing that many efficacious HDR fractionation schedules exist, some sugge sted dose and fractionation schemes for combining the EBRT with HDR brachyt herapy for each stage of disease are presented. These recommendations are i ntended only as guidelines, and the suggested fractionation schemes have no t been thoroughly tested. The responsibility for the medical decisions ulti mately rests with the treating radiation oncologist. Conclusion: Guidelines are established for HDR brachytherapy for cervical c ancer. Practitioners and cooperative groups are encouraged to use these gui delines to formulate their treatment and dose-reporting policies. These gui delines will be modified, as image-based treatment becomes more widely avai lable. (C) 2000 Elsevier Science Inc.