International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationComputed Tomography–Planned High-Dose-Rate Brachytherapy for Treating Uterine Cervical Cancer
Introduction
Patients with locally advanced cervical cancer require treatment with external beam radiation (EBRT) with concomitant cisplatin-based chemotherapy and subsequent brachytherapy (BT). Although magnetic resonance imaging (MRI) image-guided adaptive BT for cervical cancer is a gold standard, some institutions do not have access to an MRI unit, their unit is located at a significant distance from the clinic, or patients have contraindications for this method (eg, pacemaker, metal prosthesis). The Group European de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) has provided recommendations for target delineation using MRI-contoured tumor volumes and organs at risk (OAR) 1, 2. These recommendations were adapted to computed tomography (CT) BT planning 3, 4. To evaluate the long-term results of CT-planned high-dose-rate (HDR) BT for the treatment of cervical cancer patients, a retrospective analysis of the material from the Warsaw Brachytherapy Department was performed. The results were compared with the results obtained from a historical group (5).
Section snippets
Methods and Materials
In 2010 to 2011, 216 consecutive patients with locally advanced cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVA were treated with curative intent after the patients signed written consent. The protocols, consent procedure, and study were approved by the local medical authority. The eligibility criteria included patients after definitive radiation therapy and without a previous history of malignancy. Twelve patients were ineligible for the analysis, 1
Results
The median age was 56 years (range, 32-83 years). The median follow-up time for all patients was 47 months (range, 4-63 months) and for living patients was 52 months (range, 37-63 months).
The 5-year CIF (95% confidence interval [CI]) for local recurrence rate was 10.4% (9.5%-11.2%) (Fig. 1). The 5-year CIF (95% CI) for local recurrence rate for patients with FIGO II and FIGO III was 5.5% (1.5%-9.6%) and 20% (10%-30%), respectively (P=.001).
In the patients with local recurrence, the analysis of
Discussion
Computed tomography is the most commonly performed imaging modality for 3D planning of BT. Unfortunately, published reports concerning CT-based contouring in BT of cervical cancer and the outcomes of such treatment are scarce. CT, unlike MRI, does not clearly differentiate tumor tissue from normal adjacent structures; it is not possible to contour gross tumor volume. Furthermore, it is not possible to exactly define the boundary between the cervix and uterus, and the bowel loops adjacent to the
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Conflict of interest: none.