Early clinical outcomes of ultrasound-guided CT-planned high-dose-rate interstitial brachytherapy for primary locally advanced cervical XXXX .

@entity5 @entity1 @entity137 @entity3
PURPOSE: To report early clinical outcomes of high-dose-rate interstitial image-guided brachytherapy (BT) in the definitive management of locally advanced cervical @entity5 . METHODS: We retrospectively analyzed 31 locally advanced cervical @entity5 @entity1 treated at our institution between January 2010 and April 2013. About 88% had advanced disease based on the International Federation of Gynecology and Obstetrics guidelines, and 87% received concurrent chemotherapy. All @entity1 were treated with external beam radiation therapy to a median dose of 45  Gy (range, 39.6-58  Gy) before receiving BT. High-dose-rate BT was delivered in a single implant to a median dose of 6  Gy * five fractions to a CT-defined volume. Median total equivalent 2-Gy dose, dose covered by 90% of the high-risk clinical target volume (HR-CTV D90), and HR-CTV were 84, 87.4, and 49.9 cc, respectively. Kaplan-Meier method was used for actuarial survival analysis, and @entity137 was graded using Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: Median followup was 19.3  months. Two-year actuarial local control, regional control, and @entity3 ( @entity3 ) were 90%, 93%, and 23.6%, respectively. Two-year disease-free survival was 55%. Genitourinary, gastrointestinal, or gynecologic Grade 3 @entity137 was seen in 5 @entity1 (3 T4a and 2 T3b) for crude rates of 13%, 7%, and 3%, respectively. Stratifying HR-CTV by <30 and >30 cc and then by HR-CTV D90 of <85, 85-90, and >90  Gy showed that 100% of the local failures, regional failures, @entity3 , and G3 @entity137 occurred in >30 cc group. The rate of @entity3 was also significantly higher in the >30 cc group (p  =  0.036). CONCLUSIONS: An interstitial approach can achieve excellent outcomes in cases where intracavitary and/or hybrid approaches are either not suitable or not available.
