Objectives To evaluate clinical response (CR), post-recurrence survival, disease-free survival (DFS) and toxicity caused by reirradiation in pelvic recurrence of CC.
Methods A retrospective cohort study of 45 women undergoing high-dose rate interstitial brachytherapy (HDR-IB) was conducted from 1998 to 2014. Clinical information, as well as data on the malignancy, primary treatment, HDR-IB technique and toxicity were collected. Statistical analysis used Chi-square or Fisher’s test, Kaplan-Meier survival curves and log-rank test, and Cox regression, with p<0.05 for significance.
Results There were 30 cases (67%) of complete CR, with a follow-up period of 9 to 129 months (20 alive, 10 died). The 5-year post-recurrence survival rate was 52%. Among 15 women without complete CR, the survival rate was low (<8 months). In the 30 women with complete CR, the 5-year DFS was 42%. Only a larger number of needles used in HDR-IB was associated with a worse survival (Hazard Ratio=3.67, p=0.006). Ultrasonography-guided needle insertion was not associated with disease control or toxicity. Toxicity was reported in 23 women (51%) with 14 fistulas, unrelated to CR. However, there was a higher occurrence of fistula when chemotherapy or more than 12 needles were used.
Conclusions Reirradiation using HDR-IB for pelvic recurrence of CC yielded a good complete CR rate. Post-recurrence survival and DFS rates were higher than expected, equivalent to salvage surgery. Despite its significant toxicity, this technique can be an alternative for selected cases.
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