Christine Min, Presenter: Nothing to Disclose

Silvia Chiara Formenti MD, Abstract Co-Author: Nothing to Disclose

Stephanie Blank MD, Abstract Co-Author: Nothing to Disclose

Gabor Jozsef PHD, Abstract Co-Author: Nothing to Disclose

Peter B. Schiff MD, PhD, Abstract Co-Author: Nothing to Disclose

Purpose/Objective(s): Our institution adopted a novel schedule for T&O insertion and HDR brachytherapy treatment of cervical cancer in 2004. It involves the delivery of 2 fractions in 2 days with an inpatient hospital stay between each day. This is repeated a second time with a break of approximately 1-2 weeks separating each course. We are reporting outcomes of this dose-fractionation scheme compared to others published in the literature.Materials/Methods: An IRB-approved study identified a consecutive series of 40 cervical cancer patients who received whole pelvis irradiation followed by boosts to the parametria and/or regional lymph nodes, depending on the stage of the disease. 70% of patients were FIGO stage IIB, while 13% were stage IIIB, 10% were IB2, and 7% were IIA. Whole pelvis doses ranged from 4320 cGy to 4600 cGy, with a mode of 4500 cGy. All patients also received T&O insertion and HDR brachytherapy according to the aforementioned schedule. These doses ranged from 2300 cGy to 2850 cGy, with a mode of 2800 cGy. All patients received concurrent platinum-based chemotherapy. This cohort was analyzed for outcome, including recurrence-free and overall survival based on Kaplan-Meier curves, as well as toxicity.Results: At the time of the study, 6 patients had been lost to follow-up, giving us a total of 34 patients on whom data was available for analysis. 21 patients were found to have no evidence of disease. An additional 4 patients had low grade squamous intraepithelial lesions (LGSIL) that were managed with colposcopy. 7 patients had either persistent, recurrent, or metastatic disease. 6 had in-field pelvic recurrences, while 1 had local control with lung metastases. Of these, 2 were salvaged with chemotherapy with paclitaxel, 1 was to begin salvage chemotherapy, and 4 died with both locally recurrent and metastatic disease. 1 patient died of unknown causes. Based on Kaplan-Meier analysis, 5 year recurrence-free survival was 72%, and 5 year overall survival was 79%. On follow-up examination, 1 patient had rectovaginal fistula and 1 had bowel perforation, though both were also known to have recurrent disease.Conclusions: We conclude that the outcomes using this schedule, including recurrence-free and overall survival and toxicity, are comparable to those reported in the literature for other dose-fractionation schemes. This schedule is an acceptable method of delivering HDR brachytherapy in cervical cancer patients. It may assist in patient compliance, particularly in underserved populations, as it reduces the overall number of visits involved in the treatment course.

Min, C, Formenti, S, Blank, S, Jozsef, G, Schiff, P, Outcomes for High-Dose Rate (HDR) Brachytherapy with Tandem and Ovoids (T&O) in the Treatment of Cervical Cancer.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11030413.html