BRACHYTHERAPY IN THE MANAGEMENT OF CERVICAL CANCER: HACETTEPE EXPERIENCE

A total number of 85 cervical cancer patients with a minimum follow-up time of 6 months treated between May 1995 and January 2001 in our department are included in this retrospective analysis. According to FIGO system the number of the patients staged as IB2, IIA, MB, I IIA, IIIB and IVA were 4 (%4.7), 3 (%3.5), 61 (%71.8), 2 (%2.4), 13 (%15.3) and 2 (%2.4) respectively. Forty four patients underwent either retroperitoneal (38 patients) or transperitoneal (6 patients) pelvic and paraaortic lymph node dissection before radiotherapy. External radiotherapy was in the form of pelvic radiotherapy with 180 cGy daily fractions to a total dose of 5040 cGy. In case of paraaortic metastases (16 patients) paraaortic irradiation with 150 cGy daily fractionation to a total dose of 4500 cGy was added. Seventy seven patients were administered either concomittant hydroxyurea, or weekly cisplatinum during radiotherapy. High dose rate brachytherapy was administered as 700 cGy to point A beginning at the end of 3rd or 4th weeks of external therapy and applied once a week. Eighty three patients received 3 fractions of brachytherapy while 2 patients received 4 fractions. The median follow-up time is 15 months (6-39 months). Two year overall, disease free and locoregional relapse free survivals are 85%, 73% and 91 % respectively. FIGO stage, only one or both parametrial extension, tumor size, concomittant chemotherapy are the factors analyzed for prognostic significance and neither of them are found to be significant prognostic factors for disease free survival or overall survival. For locoregional disease free survival only administration of concomittant systemic therapy is found to be significant.

Keywords: cervix carcinoma, brakitherapy