Author(s): Grigsby P, Winter K, Komaki R, Marcial V, Eifel P, , Grigsby P, Winter K, Komaki R, Marcial V, Eifel P,
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Abstract PURPOSE: To evaluate the efficacy and toxicity of twice-daily external irradiation to the pelvis with brachytherapy for carcinoma of the cervix in a long-term follow-up study. METHODS AND MATERIALS: This study was designed to administer twice-daily irradiation doses of 1.2 Gy to the pelvis, 5 d/wk. Radiotherapy also included one or two low-dose-rate intracavitary implants, to deliver a total minimal dose of 85 Gy to point A and 65 Gy to the lateral pelvic lymph nodes. RESULTS: Eighty-one patients with clinical Stage IB-IVA carcinoma of the cervix were enrolled in this prospective, single arm, Phase I/II study. Hyperfractionated irradiation was completed in 88\%. Brachytherapy was given in two implants in 46\% and in one implant in 54\%. Six patients had acute Grade 3 toxicities. The cumulative rate of Grade 3 and 4 late effects for patients with Stage IB2, IIA, and IIB disease was 7\% at 3 years, 7\% at 5 years, and 10\% at 8 years. For patients with Stage III and IVA disease, the rate of late toxicities (Grades 3 and 4) was 7\% at 3 years and 12\% at 5 years. The site of first failure was in the pelvis in 41\%, para-aortic or supraclavicular lymph nodes in 6\%, and other distant metastatic sites in 14\%. The absolute survival rate was 61\% at 3 years, 48\% at 5 years, and 45\% at 8 years. The disease-free survival rate was 43\% at 3 years, 38\% at 5 years, and 33\% at 8 years. CONCLUSION: The results suggest that, combined with brachytherapy, hyperfractionated irradiation to total parametrial doses about 10\% greater than doses administered with standard fractionation pelvic irradiation was tolerated and at least appears to be as effective as standard fractionation pelvic irradiation.
This article was published in Int J Radiat Oncol Biol Phys
and referenced in Journal of Cancer Science & Therapy