Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: predictive factors for treatment outcome and early and late radiation reactions

The objective of this study was to find out predictive factors of tumor control as well as acute and late radiation reactions in treatment of advanced cervical carcinomas. In a series of 134 primary cervical carcinomas in International Federation of Gynecology and Obstetrics stages I to IV treated w...

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Bibliographic Details
Published in:	International journal of gynecological cancer Vol. 24; no. 7; p. 1268
Main Authors:	Bohr Mordhorst, Louise, Karlsson, Leif, Bärmark, Berit, Sorbe, Bengt
Format:	Journal Article
Language:	English
Published:	England 01-09-2014
Subjects:	Abdominal Cavity - radiation effects Adenocarcinoma - diagnosis Adenocarcinoma - epidemiology Adenocarcinoma - pathology Adenocarcinoma - radiotherapy Adult Aged Aged, 80 and over Brachytherapy - adverse effects Brachytherapy - methods Carcinoma, Adenosquamous - diagnosis Carcinoma, Adenosquamous - epidemiology Carcinoma, Adenosquamous - pathology Carcinoma, Adenosquamous - radiotherapy Carcinoma, Squamous Cell - diagnosis Carcinoma, Squamous Cell - epidemiology Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - radiotherapy Combined Modality Therapy Disease Progression Female Humans Middle Aged Prognosis Radiation Injuries - diagnosis Radiation Injuries - epidemiology Radiation Injuries - etiology Risk Factors Time Factors Treatment Outcome Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - epidemiology Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - radiotherapy
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Summary:	The objective of this study was to find out predictive factors of tumor control as well as acute and late radiation reactions in treatment of advanced cervical carcinomas. In a series of 134 primary cervical carcinomas in International Federation of Gynecology and Obstetrics stages I to IV treated with combined external pelvic and intraluminal cervical-vaginal brachytherapy, predictive and prognostic factors were analyzed with regard to tumor control, recurrences, survival data, and adverse effects. Concomitant chemotherapy was given to 48 patients (35.8%). The external beam therapy was given with a 4-field technique (50-60 Gy) and brachytherapy was given with a high-dose rate (iridium-192) afterloading technique using a ring applicator set. A computed tomographically based 3-dimensional dose-planning system was used for the external beam therapy and for the brachytherapy planning. The mean age of the patients was 65 years. A total of 110 tumors were squamous cell carcinomas and 24 were adenocarcinomas or adenosquamous carcinomas. A total of 111 tumors were in International Federation of Gynecology and Obstetrics stages I to II; 23 tumors, in stages III to IV. The primary control rate of the complete series was 92.5%. Tumor size, the brachytherapy dose, the combined external and brachytherapy dose, as well as the number of days of interruption (delay) of irradiation were all significant predictive factors for local tumor control. Forty recurrences (30%) were recorded. Early radiation reactions were recorded in 67% (mostly grade 1) and were associated with the widths of the anterior-posterior and lateral pelvic fields. Serious late radiations reactions (grade 3-4) were noted in 11%. The width of the lateral pelvic fields, left point A and B doses, dose to the rectal reference point, as well as asymmetry of the dose distribution were associated with late severe reactions. Prior abdominal and pelvic surgery was also a high-risk factor for late tissue reactions. Concomitant chemotherapy did not increase the risk for acute or late toxicity.
ISSN:	1525-1438
DOI:	10.1097/IGC.0000000000000208