Long-term local control and survival after concomitant boost accelerated radiotherapy for locally advanced cervix cancer

Between 1989 and 1994, a prospective clinical trial tested the safety and e fficacy of concomitant boost accelerated superfractionated (CBASF) radiothe rapy for patients with locally advanced cervix cancer. CBASF radiotherapy i ncluded 35 Gy/25 fractions to the pelvis and a 14.4 Gy/9 fraction concomita nt boost to the primary tumor, followed by brachytherapy for a total point A dose of 85 Gy to 90 Gy. The 22 patients of International Federation of Gy necology and Obstetrics stages IIIA-IVA who received CBASF radiotherapy now have a median follow-up time of more than 8 years, The 7-year actuarial ra tes of local control and overall survival are 81% and 36%, respectively. Se rious late toxicity included bowel injury requiring colostomy in eight pati ents within 2.5 years after treatment, but no other severe toxicity was obs erved after longer follow-up intervals. The local control and survival rate s achieved with CBASF radiotherapy were higher than those observed within a matched contemporaneous cohort of patients treated with standard radiother apy alone at the same institution (p = 0.1 for local control, 0.09 for surv ival). The encouraging trend toward improved tumor control, tempered by the complication rate, suggests an opportunity to apply more sophisticated rad iotherapy techniques that might sustain the favorable effects of dose inten sification while mitigating the normal tissue toxicity.