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Reirradiation Using High-Dose-Rate Interstitial Brachytherapy for Locally Recurrent Cervical Cancer: A Single Institutional Experience
  1. Seiji Mabuchi, MD, PhD*,
  2. Ryoko Takahashi, MD*,
  3. Fumiaki Isohashi, MD, PhD,
  4. Takeshi Yokoi, MD, PhD*,
  5. Mika Okazawa, MD*,
  6. Tomoyuki Sasano, MD, PhD*,
  7. Shintaroh Maruoka, MD,
  8. Makoto Anzai, MD,
  9. Yasuo Yoshioka, MD, PhD,
  10. Kazuhiko Ogawa, MD, PhD and
  11. Tadashi Kimura, MD, PhD*
  1. *Departments of Obstetrics and Gynecology, and
  2. Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
  1. Address correspondence and reprint requests to Seiji Mabuchi, MD, PhD, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. E-mail: smabuchi{at}gyne.med.osaka-u.ac.jp.

Abstract

Objectives This study aimed to evaluate the effectiveness and feasibility of reirradiation using high-dose-rate interstitial brachytherapy (HDR-ISBT) in patients with recurrent cervical cancer.

Methods The records of 52 consecutive women with central pelvic recurrence who were salvaged with HDR-ISBT–based reirradiation were retrospectively reviewed. Data regarding the primary disease, follow-up findings, recurrence, the treatment outcome, and toxicities were collected. Multivariate analysis was performed using the Cox proportional hazards regression model to identify predictors of the response to HDR-ISBT. Survival rate was calculated using the Kaplan-Meier method and compared using the log-rank test.

Results A total of 52 patients who had been treated with HDR-ISBT–based reirradiation were included in our database. The local control rate was 76.9% (40/52), and the median postrecurrence survival period was 32 months. Grade 3 or 4 late toxicities were observed in 13 patients (25%). Multivariate analysis revealed that tumor size and the treatment-free interval were significant poor prognostic factors of postrecurrence survival. In a comparison between the patients who were salvaged with HDR-ISBT–based reirradiation (ISBT group) and those who were treated with palliative therapy alone (palliative group), we found that among the patients who displayed 0 or 1 poor prognostic factors, the patients in the ISBT group survived significantly longer than those in the palliative group. In contrast, similar survival rates were seen in both groups among the patients with 2 or more poor prognostic factors.

Conclusions Reirradiation using HDR-ISBT is effective and feasible in patients with recurrent cervical cancer. Our 2-clinical variable prognostic model might enable physicians to identify patients who would not derive clinical benefit from HDR-ISBT and offer them the opportunity to receive other types of treatment.

  • HDR-ISBT
  • Reirradiation
  • Recurrent cervical cancer
  • Survival

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Footnotes

  • This study was supported in part by Grant-in-Aid for General Scientific Research No. 23592446 from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

  • The authors declare no conflicts of interest.

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