Inverse Planned High-Dose-Rate Brachytherapy for Locoregionally Advanced Cervical XXXX : 4-Year Outcomes.

@entity1 @entity137 @entity5 @entity900 @entity3
PURPOSE: Evaluate the efficacy and @entity137 of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced @entity5 . METHODS AND MATERIALS: From December 2003 through September 2009, 111 @entity1 with @entity5 were treated definitively with IPSA-planned HDRB boost (28  Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the @entity1 , 70% had a @entity5 size >4  cm, 38% had regional nodal disease, and 15% had clinically evident distant @entity3 , including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of @entity1 , and 93% received concurrent @entity900 -based chemotherapy. @entity137 are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. RESULTS: With a median follow-up time of 42  months (range, 3-84  months), no acute or late @entity137 of grade 4 or higher were observed, and grade 3 @entity137 (both acute and late) developed in 8 @entity1 (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 @entity137 was 8%. Local recurrence developed in 5 @entity1 (4 to 9  months after HDRB), regional recurrence in 3 (6, 16, and 72  months after HDRB), and locoregional recurrence in 1 (4  months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4  years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. CONCLUSIONS: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced @entity5 is well tolerated and achieves excellent local control of disease. However, overall survival continues to be limited by the high rates of distant @entity3 .
