3D image guided adaptive brachytherapy in patients with locally advanced cervical cancer: experience and clinical results from a minimum of six years of follow-up

Abstract

In 2005, individualized 3D image guided brachytherapy was implemented for cervical cancer patients, in accordance with the (GYN) GEC ESTRO recommendation, at St. Olav's Hospital, Trondheim, Norway. This study reports the clinical results of sixty-five consecutive patients treated from 2005 to 2010. The patients were treated with curative intent using external beam radiotherapy, brachytherapy and cisplatin. Results of this treatment are presented, including Kaplan-Meier estimates for overall survival (OS) and cancer specific survival (CSS), as well as biological effective dose normalized to equivalent 2 Gy fractions to tumor, defined as high-risk clinical target volume (CTVHR ), and to organs at risk (OARs, here bladder and rectum). Morbidity was prospectively assessed and scored in accordance with the CTCAE 3.0. 92% of the patients achieved treatment response. Local control (LC) remained in all but one patient during follow-up. Five-year OS and CSS were 71% and 80%, respectively. The mean minimum dose to CTVHR for all patients was 80.2 ± 7.3 Gy; 16% and 23% of the patients developed bladder and GI symptoms respectively, 14% of all symptoms were categorized as serious (CTCAE score ≥ 3). A dose-effect relationship was observed for adverse effects of the bladder, and the findings support the more recently recommended lower total dose limit for this OAR.