Chemoradiotherapy of cervical cancer by use of lower amount of brachytherapy sessions
I. Isayev, K. Akbarov, E. Guliyev, N. Aliyeva
National Center of Oncology, Baku, Azerbaijan
Background: it is well known that brachytherapy is the important tool allowing radiation oncologists to escalate the dose of ionizing radiation to the cervical carcinoma. Now four to six fractions high dose rate brachytherapy delivery is the most widely accepted regimen. In this study we evaluated treatment outcomes in patients with locally advanced cervical cancer treated with chemoradiation and two HDR brachytherapy fractions by nine Gy.
Methods: We studied treatment and investigation results of 246 patients with IIA - IIIB stage uterine cervical cancer which were treated at National Center of Oncology, Baku, Azerbaijan from 2008 to 2013. Median age of patients was 53,2 years (31-76). 44 (17,9%) patients had IIA, 115 (46,8%) – IIB, 13(5,3%) – IIIA, 74 (30 %) – IIIB stage cervical cancer. Histological analysis showed 213 (86,6%) cases of squamous cell cancer, 21 (8,5%) adenocarcinomas and 12 (4,8%) cases of anaplastic carcinoma. 127 patients received external beam radiotherapy (without central shielding) to the pelvis in 2 Gy daily fractions, 5 times weekly up to 46-50 Gy. Beginning with the first fraction of external beam radiotherapy patients also received cisplatin in dose 40 mg/m2 weekly during 5 weeks. After 46 Gy of external irradiation high dose rate brachytherapy (192Ir source) was initiated: two weekly fractions of nine Gy. 119 patients received the same treatment but with four times seven Gy HDR brachytherapy.
Results: Studentized statistic method was used for statistical evaluation of the results. Survival rates were calculated by Kaplan-Mayer method. For all statistical tests p<0.05 was considered significant. All patients completed radiotherapy as planned and 91,4% patients received at least four cycles of chemotherapy. Median duration of treatment course was 46,3 days. We did not reveal significant differences in five year overall survival between two groups of patients (actuarial five year overall survival rates were 63,1% and 65,9%, respectively, р < 0,05). We also did not reveal any significant differences in late treatment related toxicity between two groups.
Conclusion: Inspite of different fractionation regimens (four times seven Gy and two times nine Gy) there is no significant advantage between these regimens according to the five year overall survival and probability of late treatment related toxicity. So 2x9 Gy HDR brachytherapy regimen could be feasible from better patient compliance, less complications probability (anesthesiology, bleeding) and medical staff business point of view.