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Phase II study of the American Brachytherapy Society guidelines for the use of high–dose rate brachytherapy in the treatment of cervical carcinoma: is 45–50.4 Gy radiochemotherapy plus 31.8 Gy in six fractions high–dose rate brachytherapy tolerable?
  1. T. P. Shakespeare,
  2. K. H.C. Lim,
  3. K. M. Lee,
  4. M. F. Back,
  5. R. Mukherjee and
  6. J. D. Lu
  1. Department of Radiation Oncology, National University Hospital, Singapore, Singapore
  1. Address correspondence and reprint requests to: Keith Hsiu Chin Lim, MBBS, Department of Radiation Oncology, National University Hospital, 5 Lower Kent Ridge Road, Radiotherapy Centre, Level 3, Singapore 119074. Email: keith_LIM{at}


In 2000, the American Brachytherapy Society (ABS) published incompletely evaluated guidelines for curative chemoradiation and high–dose rate (HDR) brachytherapy for cervical cancer: our aim was to assess guideline tolerability in an Asian population. From 2000, all stage I–IVA cervical carcinoma patients were treated following ABS guidelines. Early disease (FIGO stage I/II <4 cm) received 45 Gy whole-pelvis external-beam radiation (EBRT) at 1.8 Gy/fraction, while advanced-stage disease received 50.4 Gy: no central shielding was used. All patients were planned to receive chemotherapy during EBRT, cisplatin 40 mg/m2 weekly. All patients received 31.8-Gy HDR brachytherapy (six fractions of 5.3 Gy/fraction) to point A via three-channel applicators. Radiotherapy was completed within 8 weeks. Toxicity scoring used Common Toxicity Criteria. Nineteen of 21 (90.4%) patients (8 early, 13 advanced stage) received planned radiation, and 85.7% received planned chemotherapy. Median follow-up was 24 months (range 9–50 months). Three-year overall survival (S) was 79.1% and disease-free survival (DFS) was 64.8%. S/DFS for early and advanced stage was 85.7%/85.7% and 73.3%/47.1%, respectively. Complete response (CR) was achieved by 85.7% of patients, partial response 14.3%. For those in CR, there were no local failures. Acute cystitis occurred in 23.8%, proctitis 4.8%, and gastroenteritis 47.6%. Late cystitis occurred in 9.5%, gastroenteritis 4.8%, and genitourinary fistula (in the presence of progressive disease) 4.8%. No grade 3/4 treatment-related toxicity occurred. The ABS guidelines were well tolerated and efficacious in our study, although longer follow-up is required. Further studies are warranted to validate safety and efficacy of the recommendations.

  • ABS
  • HDR brachytherapy
  • cervical cancer

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