CT-planned HDR brachytherapy for treating uterine cervical cancer
Menée sur 216 patientes atteintes d'un cancer du col de l'utérus de stade localement avancé traité par radiothérapie externe en combinaison avec une chimiothérapie concomitante (âge médian : 56 ans ; durée médiane de suivi : 52 mois), cette étude évalue l'efficacité, du point de vue du contrôle local de la maladie et des taux de survie à 5 ans, et la toxicité d'une curiethérapie à haut débit de dose guidée par tomodensitométrie
Purpose : To evaluate the long-term results of CT-planned high dose rate (HDR) brachytherapy (BT) for treating cervical cancer patients. Materials and Methods : CT-planned HDR BT was performed according to the adapted GEC-ESTRO recommendations on 216 consecutive patients with locally advanced cervical cancer FIGO stage IB-IVA who were treated with conformal EBRT and concomitant chemotherapy. We analyzed outcomes and late side effects evaluated according to the RTOG/EORTC and SOMA evaluation scoring system and compared them to the results from a historical group. Results : The median age was 56 years (range 32-83). The median follow-up for living patients was 52 months (range: 37-63). The 5-year cumulative incidence function for the local recurrence rate for patients with FIGO II and III was 5.5% and 20%, respectively (p=0.001). The 5-year overall survival and disease free survival rate was 66.4% and 58.5%, respectively. The relative risk of failure for OS and DFS for FIGO III in relation to FIGO II was 2.24 (p=0.003) and 2.6 (p=0.000) and for lymph node enlargement was 2.3 (p=0.002) and 2 (p=0.006), respectively. In two patients, recto-vaginal fistula occurred, and in one patient, vesico-vaginal fistula occurred without local progression. Comparison of late complications in patients treated according to GEC-ESTRO recommendations and in the historical group revealed a reduction in fistula formation of 59% and also over a 50% reduction in rectal grade 3-4 late toxicity. Conclusions : This is the largest report with mature data of CT-planned BT HDR for the treatment of cervical cancer with good local control and acceptable toxicity. Compared to the historical series, there is a substantial benefit in terms of severe late effects. FIGO III and enlarged lymph no
http://www.redjournal.org/article/S0360-3016%2816%2930136-5/abstract 2016