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Wu H, He Y, Chen D, Liu M, Zhao X. High-dose-rate brachytherapy in uterine cervix carcinoma: a comparison of dosimetry and clinical outcomes among three fractionation schedules. Front Oncol 2024; 14:1366323. [PMID: 39070146 PMCID: PMC11272520 DOI: 10.3389/fonc.2024.1366323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Background To assess the differences among three dose-fractionation schedules of image-guided adaptive brachytherapy (IGABT) in cervical squamous cell carcinoma (CSCC) by comparing the dosimetry and clinical outcomes. Methods Forty-five patients with CSCC who underwent chemoradiotherapy and IGABT were retrospectively enrolled and divided into three groups based on their dose-fractionation schedules of brachytherapy as: Group-5.5 (5.5 Gy × 6 fractions), Group-6.0 (6.0 Gy × 5 fractions), and Group-7.0 (7.0 Gy × 4 fractions). The analyzed dose-volume histogram parameters included D90% and D98% of the high-risk clinical target volume (HR-CTV), D90% and D98% of intermediate-risk clinical target volume (IR-CTV), and D0.1cc and D2cc of the organs-at-risk (OARs, namely the bladder, rectum, sigmoid and small intestine). Furthermore, the therapeutic efficacy and late toxicities were also compared among the three groups. Results The doses of HR-CTV and IR-CTV in Group-5.5 were found to be the highest among the three groups, followed by those in Group-6.0. Significant differences were found for the doses of HR-CTV between Group-5.5 and the other groups. There were no significant differences in the bladder, sigmoid and small intestine dose among the three groups. However, Group-6.0 yielded the lowest rectum received doses, with a significant difference in D0.1cc being detected between Group-6.0 and Group-5.5. The median follow-up time was 30.08 months [range, 6.57-46.3]. The numbers of patients with complete response in Group-5.5, Group-6.0 and Group-7.0 were 13, 14 and 14, respectively (P > 0.05). In regard to the toxicitiy, the incidence of radiation cystitis and proctitis in Group-6.0 was lower than that in Group-5.5 and Group-7.0 (P > 0.05). Conclusions The dose-fractionation schedule of 6.0 Gy × 5 fractions provided the most beneficial effects with relatively low OARs doses, suggesting that this dose-fractionation schedule should be prioritized in the clinical application of brachytherapy in cervical cancer.
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Affiliation(s)
- Haiyan Wu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
- Department of Gynecological Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yanan He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Duke Chen
- Department of Gynecological Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Mei Liu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
- Department of Gynecological Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiujuan Zhao
- Department of Gynecological Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Chuk E, Yu C, Scott AA, Liu ZA, Milosevic M, Croke J, Fyles A, Lukovic J, Rink A, Beiki-Ardakani A, Borg J, Skliarenko J, Conway JL, Weersink RA, Han K. Clinical Outcomes of 3 Versus 4 Fractions of Magnetic Resonance Image-Guided Brachytherapy in Cervical Cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00745-4. [PMID: 38936633 DOI: 10.1016/j.ijrobp.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/30/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Magnetic resonance image-guided brachytherapy is essential in the management of locally advanced cervical cancer. This study compares disease and toxicity outcomes in cervical cancer patients treated with 24 Gy/3 fractions (Fr) versus the conventional 28 Gy/4 Fr. METHODS AND MATERIALS This retrospective study included 241 consecutive patients with International Federation of Gynecology and Obstetrics 2018 stage IB to IVA cervical cancer treated with definitive chemoradiation between April 2014 and March 2021. Disease-free survival (DFS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Cumulative incidence of local failure (LF), distant failure (DF), and G2+ gastrointestinal (GI), urinary and vaginal toxicity were estimated using the cumulative incidence function with death as a competing risk and compared using Gray's test. RESULTS Of the 241 patients, 42% received 24 Gy/3 Fr and 58% received 28 Gy/4 Fr. With a median follow-up of 3.2 (range, 0.2-9.2) years, there were 14 local, 41 regional nodal, and 51 distant failures in 63 (26%) patients. No significant differences were found between the 24 Gy/3 Fr and 28 Gy/4 Fr groups in 3-year DFS (77% vs 68%, P = .21), the 3-year cumulative incidence of LF (5% vs 7%, P = .57), DF (22% vs 25%, P = .86), G2+ GI toxicity (11% vs 20%, P = .13), or G2+ vaginal toxicity (14% vs 17%, P = .48), respectively. The 3-year cumulative G2+ urinary toxicity rate was lower in the 24 Gy/3 Fr group (9% vs 23%, P = .03). CONCLUSIONS Patients with cervical cancer treated with 24 Gy/3 Fr had similar DFS, LF, DF, GI, and vaginal toxicity rates and a trend toward a lower G2+ urinary toxicity rate compared with those treated with 28 Gy/4 Fr. A less resource-intensive brachytherapy fractionation schedule of 24 Gy/3 Fr is a safe alternative to 28 Gy/4 Fr for definitive treatment of cervical cancer.
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Affiliation(s)
- Elizabeth Chuk
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Candice Yu
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Aba Anoa Scott
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michael Milosevic
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Jennifer Croke
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Anthony Fyles
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jelena Lukovic
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alexandra Rink
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Akbar Beiki-Ardakani
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jette Borg
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Julia Skliarenko
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jessica L Conway
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Robert A Weersink
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Kathy Han
- Princess Margaret Cancer Centre, University Health Network, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
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Gagrani V, Kabara J, Shukla A, Rathore NK, Rajpurohit VS, Jangid PK, Manna S. A comparative study between two different dose fractionation schedules of cobalt-60-based HDR intracavitary brachytherapy in carcinoma cervix stages IIB-IIIC1. J Cancer Res Ther 2024:01363817-990000000-00058. [PMID: 38261446 DOI: 10.4103/jcrt.jcrt_286_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION High dose rate (HDR) intracavitary brachytherapy (ICBT) is an integral element in the treatment of carcinoma uterine cervix. The main objective of brachytherapy in carcinoma cervix is to deliver a lethal dose to tumor cells without inducing unacceptable damage to the surrounding normal tissue. Because the absorbed dose falls off rapidly, higher doses can be safely delivered to the targeted tissue over a short time. The quest for optimum dose and fractionation schedule in HDR ICBT is still ongoing, and there is no uniform consensus. This study aimed to assess the acute dose-related toxicities of HDR brachytherapy schedule of 7 Gy x 3 fractions over 6 Gy x 4 fractions in the treatment of cervical cancer. OBJECTIVE The aim of this study was to study the acute treatment-related gastrointestinal (GI) and genitourinary (GU) toxicities between two HDR brachytherapy regimens. MATERIAL AND METHODS This is a prospective institutional study carried out from May 2018 to September 2018. In this time period, 66 patients of cervical cancers fulfilling our inclusion criteria were treated with concurrent chemoradiation (CCRT) following brachytherapy. During treatment, patients were randomized to arm A-7 Gy per fraction for three fractions and arm B-6 Gy per fraction for four fractions. Acute GI and GU toxicities were assessed using Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03. All patients were kept for follow-up for 3 months in this study. RESULTS There is no statistically significant difference between the two arms for acute GI and GU toxicities, and the results were comparable. CONCLUSIONS Considering the increased hospital burden of locally advanced cervical cancer patients in the Indian context, the HDR brachytherapy schedule of 7 Gy per fraction is preferable to 6 Gy per fraction for a lesser fractionation schedule.
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Affiliation(s)
- Vaibhav Gagrani
- Department of Radiation Oncology, Asian Cancer Hospital, Jaipur, Rajasthan, India
| | - Jyoti Kabara
- Department of Anesthesia, GBH Medical College and General Hospital, Udaipur, Rajasthan, India
| | - Arvind Shukla
- Department of Radiation Oncology, RNT Medical College, Udaipur, Rajasthan, India
| | - N K Rathore
- Department of Radiation Oncology, RNT Medical College, Udaipur, Rajasthan, India
| | - Vikram S Rajpurohit
- Department of Radiation Oncology, RNT Medical College, Udaipur, Rajasthan, India
| | - Pawan K Jangid
- Department of Radiation Oncology and Medical Physics, SMS Medical College, Jaipur, Rajasthan, India
| | - Sumanta Manna
- Specialty of Medical Physics, Kalyan Singh Super Specialty Cancer Institute, Lucknow, Uttar Pradesh, India
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Mayadev J, Viswanathan A, Liu Y, Li CS, Albuquerque K, Damato AL, Beriwal S, Erickson B. American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer. Brachytherapy 2017; 16:22-43. [PMID: 28109631 DOI: 10.1016/j.brachy.2016.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Advanced imaging used in combination with brachytherapy (BT) has revolutionized the treatment of patients with cervical cancer. We present a comprehensive review of the literature for definitive radiation with high-dose-rate (HDR) BT. In addition, we investigate potential outcome improvement with image-based brachytherapy (IBBT) compared to studies using traditional Point A dosing. This review extensively investigates acute and late toxicities. METHODS AND MATERIALS This study reviews the literature from 2000 to 2015 with an emphasis on modern approaches including concurrent chemotherapy (chemoRT), radiation, and HDR BT and IBBT. Descriptive statistics and pelvic control (PC), disease-free survival (DFS), and overall survival (OS) outcomes were calculated using weighted means to report pooled analysis of outcomes. RESULTS Literature search yielded 16 prospective, 51 retrospective studies that reported survival outcomes, and 13 retrospective studies that focused on acute and late toxicity outcomes regardless of applicator type. There are 57 studies that report Point A dose specification with 33 having chemoRT, and 10 studies that use IBBT, 8 with chemoRT. Patients receiving radiation and chemoRT with HDR BT in the prospective studies, with >24 months followup, rates of PC were: for RT: 73%, SD: 11; CRT: 82%, SD: 8; DFS-RT: 55%, SD: 10; CRT: 65%, SD: 7; OS-RT: 66%, SD: 7; CRT: 70%, SD: 11. In the retrospective studies, the PC rates (weighted means) for the radiation and chemoradiation outcomes are 75% vs. 80%, and for DFS, the values were 55% vs. 63%, respectively. Comparing patients receiving chemoRT and IBBT to traditional Point A dose specification, there is a significant improvement in PC (p < 0.01) and DFS (p < 0.01) with IBBT. The range of genitourinary late toxicity reported for radiation was Grade 3: 1-6% and for chemoRT 2-20%. The range of late gastrointestinal toxicity for radiation was Grade 3: 4-11% and for chemoRT, 1-11%. For the late gynecologic toxicity, only 1 of the 16 prospective trials report a Grade 1-2 of 17% for radiation and 9% for chemoRT effects. CONCLUSIONS We present concise outcomes of PC, DFS, OS, and toxicity for cervical cancer patients treated with chemoradiation and HDR BT. Our data suggest an improvement in outcomes with the use of IBBT compared with traditional Point A dose prescriptions. In conclusion, HDR BT is a safe, effective modality when combined with IBBT.
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Affiliation(s)
- Jyoti Mayadev
- Department of Radiation Oncology, Davis Medical Center, University of California, Sacramento, CA.
| | - Akila Viswanathan
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Yu Liu
- Department of Biostatistics, Davis Medical Center, University of California, Sacramento, CA
| | - Chin-Shang Li
- Department of Biostatistics, Davis Medical Center, University of California, Sacramento, CA
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Antonio L Damato
- Department of Radiation Oncology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburg Medical Center, Pittsburgh, PA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin Medical Center, Milwaukee, WI
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Liu R, Wang X, Tian JH, Yang K, Wang J, Jiang L, Hao XY. High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer. Cochrane Database Syst Rev 2014; 2014:CD007563. [PMID: 25300170 PMCID: PMC8734152 DOI: 10.1002/14651858.cd007563.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in 2010 (Issue 7).Carcinoma of the uterine cervix is the second most common cancer and the third leading cause of cancer death among women. Radiotherapy has been used successfully to treat cervical cancer for nearly a century. The combination of external beam radiotherapy (EBRT) and intracavity brachytherapy (ICBT) has become a standard treatment for cervical cancer. Whether high dose rate (HDR) or low dose rate (LDR) brachytherapy improves outcomes in terms of local control rates, survival and complications for women with cervical cancer remains controversial. OBJECTIVES To assess the efficacy and safety of HDR versus LDR ICBT in combination with EBRT for women with uterine cervical cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to March 2014), EMBASE (1974 to March 2014), and the Chinese Biomedical Literature Database (CBM) (1978 to March 2014) for relevant original, published trials. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that compared HDR with LDR ICBT, combined with EBRT, for women with locally advanced uterine cervical cancer. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data using standardised forms. Primary outcome measures included overall survival (OS), relapse-free survival (RFS) and pelvic control rate, while secondary outcomes included rates of recurrence and complications. MAIN RESULTS Four studies involving 1265 women met the inclusion criteria. In our meta-analysis to compare HDR and LDR ICBT, the pooled risk ratios (RRs) were 0.95 (95% confidence interval (CI) 0.79 to 1.15), 0.93 (95% CI 0.84 to 1.04) and 0.79 (95% CI 0.52 to 1.20) for 3-, 5- and 10-year overall survival rates respectively; and 0.95 (95% CI 0.84 to 1.07) and 1.02 (0.88 to 1.19) for 5- and 10-year disease-specific survival (DSS) rates respectively. The RR for RFS was 1.04 (95% CI 0.71 to 1.52) and 0.96 (95% CI 0.81 to 1.14) at 3- and 5- years. For local control rates the RR was 0.95 (95% CI 0.86 to 1.05) and 0.95 (95% CI 0.87 to 1.05) at 3- and 5- years; with a RR of 1.09 (95% CI 0.83 to 1.43) for locoregional recurrence, 0.79 (95% CI 0.40 to 1.53) for local and distant recurrence, 2.23 (95% CI 0.78 to 6.34) for para-aortic lymph node metastasis, and 0.99 (95% CI 0.72 to 1.35) for distance metastasis. For bladder, rectosigmoid and small bowel complications, the RR was 1.33 (95% CI 0.53 to 3.34), 1.00 (95% CI 0.52 to 1.91) and 3.37 (95% CI 1.06 to 10.72) respectively. These results indicated that there were no significant differences except for increased small bowel complications with HDRs (P = 0.04). AUTHORS' CONCLUSIONS Since the last version of this review, no new studies were identified for inclusion in this review to provide additional information. This review showed no significant differences between HDR and LDR ICBT when considering OS, DSS, RFS, local control rate, recurrence, metastasis and treatment related complications for women with cervical carcinoma. Due to some potential advantages of HDR ICBT (rigid immobilization, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualized treatment) we recommend the use of HDR ICBT for all clinical stages of cervix cancer. The overall risk of bias was high for the included studies as many of the items were either of high or unclear risk. The GRADE assessment of the quality of the evidence was low to moderate.
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Affiliation(s)
- Ruifeng Liu
- Radiation Oncology Centre of Gansu Tumour Hospital, Lanzhou Univeristy, No. 2, Xioaxihu East Road, Lanzhou City, Gansu, China, 730050
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Tharavichitkul E, Klunkin P, Lorvidhaya V, Sukthomya V, Chakrabhandu S, Pukanhaphan N, Chitapanarux I, Galalae R. The effects of two HDR brachytherapy schedules in locally advanced cervical cancer treated with concurrent chemoradiation: a study from Chiang Mai, Thailand. JOURNAL OF RADIATION RESEARCH 2012; 53:281-287. [PMID: 22510600 DOI: 10.1269/jrr.11038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Efficacy of different schedules of HDR brachytherapy in concurrent chemoradiotherapy was evaluated. The study compared the effectiveness of the two HDR brachytherapy schedules which have the same Biological Effective Dose (BED) in locally advanced cervical carcinoma that was treated with concurrent chemoradiotherapy. Included in the study were 377 randomly selected patients with advanced carcinoma of the cervix uteri who were treated during the period 2004-2006. Patients were divided into Group I: 7.2 Gy × 3 fractions and Group II: 6 Gy × 4 fractions. With a median follow-up time of 35 months, local control, disease-free survival and overall survival rates were 80.8%, 63.4%, 98.8% in group I and 86.7%, 63.8%, 97.3% in group II, respectively. There was no statistical significance in terms of local control, disease-free survival, overall survival and complication rates between the two treatment schedules which could be observed. Seven patients in group I developed acute grade 2-4 GI toxicities and two patients in group II. In GU toxicities, there were three patients in group I and three patients in group II who developed grade 2-4 toxicities. In late toxicity, no patient developed grade 3-4 GU toxicities in group I while two patients developed grade 3-4 GU toxicities in group II. In GI toxicities, there were five and six patients in group I and group II, respectively, who developed grade 3-4 severity. Both HDR schedules seem to be safe and effective for the treatment of locally advanced cervical cancer.
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Affiliation(s)
- Ekkasit Tharavichitkul
- The Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University, Thailand.
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Wang X, Liu R, Ma B, Yang K, Tian J, Jiang L, Bai ZG, Hao XY, Wang J, Li J, Sun SL, Yin H. High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer. Cochrane Database Syst Rev 2010:CD007563. [PMID: 20614461 DOI: 10.1002/14651858.cd007563.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Carcinoma of the uterine cervix is the second most common cancer and the third leading cause of cancer death among women. Radiotherapy has been used successfully to treat cervical cancer for nearly a century. The combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) has become a standard treatment modality for cervical cancer. Depending on the difference in dose rate on 'Point A' (located 2 cm above the cervical os and 2 cm lateral to the central axis of the uterus), the ICBT is divided into three modalities: low dose rate (LDR), high dose rate (HDR) and medium dose rate (MDR). Despite the practical advantages of HDR, it is necessary to investigate further the efficacy and safety of HDR brachytherapy compared to LDR brachytherapy. Questions arise as to whether HDR or LDR brachytherapy improves results for patients with cervical cancer in terms of local control rates, survival and complications related to treatment. OBJECTIVES To assess the efficacy and safety of HDR- versus LDR-ICBT for patients with uterine cervical cancer. SEARCH STRATEGY We searched the Cochrane Gynaecological Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to November 2009), EMBASE (1974 to November 2009), Chinese Biomedical Literature Database (CBM) (1978 to November 2009) for relevant original, published trials. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that compared HDR- with LDR-ICBT, combined with EBRT, for patients with locally advanced uterine cervical cancer. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data using standardised forms. Primary outcome measures included overall survival (OS), relapse-free survival (RFS) and pelvic control rate, while secondary outcomes included rates of recurrence and complications. MAIN RESULTS Four studies involving 1265 patients met the inclusion criteria. In our meta-analysis to compare HDR and LDR, the pooled RRs were 0.95 (95% CI 0.79 to 1.15), 0.93 (95% CI 0.84 to 1.04) and 0.79 (95% CI 0.52 to 1.20) for 3-, 5- and 10-year overall survival rates; and 0.95 (95% CI 0.84 to 1.07) and 1.02 (0.88 to 1.19) for 5- and 10-year disease-specific survival (DSS) rates. The RR for RFS was 1.04 (95% CI 0.71 to 1.52) and 0.96 (95% CI 0.81 to 1.14) at three and five years. For local control rates the RR was 0.95 (95% CI 0.86 to 1.05) and 0.95 (95% CI 0.87 to 1.05) at three and five years; with a RR of 1.09 (95% CI 0.83 to 1.43) for locoregional recurrence, 0.79 (95% CI 0.40 to 1.53) for local and distance recurrence, 2.23 (95% CI 0.78 to 6.34) for para-aortic lymph node metastasis and 0.99 (95% CI 0.72 to 1.35) for distance metastasis. For bladder, rectosigmoid and small bowel complications, the RR was 1.33 (95% CI 0.53 to 3.34), 1.00 (95% CI 0.52 to 1.91) and 3.37 (95% CI 1.06 to 10.72), respectively. These results indicate that there were no significant differences except for increased small bowel complications with HDR (P = 0.04). AUTHORS' CONCLUSIONS This review showed no significant differences between HDR- and LDR-ICBT when considering OS, DSS, RFS, local control rate, recurrence, metastasis and treatment related complications for women with cervical carcinoma. Due to some potential advantages of HDR-ICBT (rigid immobilization, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualized treatment) we recommend the use of HDR-ICBT for all clinical stages of cervix cancer.
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Affiliation(s)
- Xiaohu Wang
- Radiation Oncology Centre of Gan Su Tumour Hospital, Lanzhou University, 199 Dongang West Road, Lanzhou City, Gansu, China, 730000
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