International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: cervixThe American Brachytherapy Society recommendations for low-dose-rate brachytherapy for carcinoma of the cervix
Introduction
The success of radiation therapy requires the delivery of a high radiation dose directly to the tumor while sparing, to some degree, the surrounding normal tissues. Low-dose-rate (LDR) brachytherapy has traditionally been an important component in the overall management of patients with cervical carcinoma. Some institutions are now using high-dose-rate (HDR) brachytherapy. Several studies (including randomized and nonrandomized prospective clinical trials, surveys of published studies, and meta-analyses) have compared HDR brachytherapy to LDR brachytherapy in the management of cervical cancer. These have demonstrated comparable local control, survival, and morbidity 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. A discussion of the debate over the use of LDR and HDR brachytherapy to treat cervical cancer is beyond the scope of this report. The increased integration of chemotherapy has also affected the practice pattern in cervical cancer.
The curative potential of radiation therapy in the management of carcinoma of the cervix is greatly enhanced by the use of intracavitary brachytherapy 14, 15, 16, 17. Although LDR intracavitary brachytherapy has been in use for many years, there is wide variation in its clinical practice (18). Although some dose specification and reporting guidelines exist for gynecologic brachytherapy (ICRU Report 38) (19), they are not widely accepted 20, 21. The American Brachytherapy Society (ABS) has recently issued recommendations for HDR brachytherapy for cervical cancer (22) and felt that specific recommendations should also be provided for LDR brachytherapy for cervical carcinoma. The ABS recognizes that because of the wide variation in clinical practice, it may be difficult to obtain a consensus agreeable to all practitioners.
Section snippets
Methods and materials
Members of the ABS with expertise in LDR cervical brachytherapy performed a literature review and, guided by their clinical experience, formulated specific recommendations and directions for future investigation in LDR cervical brachytherapy. These recommendations were made by consensus opinion and supported by published data whenever possible. In addition, an external multispecialty panel of recognized experts in the field reviewed the consensus recommendations. Revisions were made where
Results
The results of the deliberation of the panel and the ABS recommendations are given in the following sections. These recommendations were at Level 1 consensus, unless specifically noted to be of Level 2 consensus. None of the recommendations was at consensus Level 3.
Conclusion
The ABS has established guidelines for LDR brachytherapy for cervical cancer. The responsibility for medical decisions ultimately rests with the treating radiation oncologist. Practitioners and cooperative groups are encouraged to use these recommendations to formulate treatment and dose-reporting policies.
Acknowledgements
The authors express their gratitude to David Carpenter for editorial assistance. The authors acknowledge the support of the American Brachytherapy Society Board of Directors. We thank Drs. Kaled Alektiar, Alison Calkins, Michael Dullea, Patricia Eifel, Kathy Greven, Jean-Claude Horiot, Robin Hunter, Anuja Jhingran, Robert Kim, Wui-Jin Koh, Jeffery Lee, Jeffery Long, Anita Mahajan, Gustavo Montana, Arno Mundt, Colin Orton, Nilam Ramsinghani, Marcus Randall, Kevin Redmond, Christopher Sinesi,
References (132)
- et al.
Dose equivalence for high-dose rate to low-dose rate intracavitary irradiation in the treatment of cancer of the uterine cervix
Int J Radiat Oncol Biol Phys
(1990) - et al.
High-dose rate vs low-dose rate intracavitary brachytherapy for carcinoma of the cervix
Int J Radiat Oncol Biol Phys
(1990) - et al.
Comparison of high and low dose rate remote afterloading for cervix cancer and the importance of fractionation
Int J Radiat Oncol Biol Phys
(1991) - et al.
Low dose rate vs HDR brachytherapy in the treatment of carcinoma of the uterine cervixA clinical trial
Int J Radiat Oncol Biol Phys
(1994) - et al.
A comparison of the efficacy and complication rates of low-dose rate vs high-dose rate brachytherapy in the treatment of uterine cervical carcinoma
Int J Radiat Oncol Biol Phys
(1994) - et al.
Treatment of carcinoma of the uterine cervix by remotely controlled afterloading intracavitary radiotherapy with HDRA comparative study with a low-dose rate system
Int J Radiat Oncol Biol Phys
(1983) - et al.
Literature analysis of high dose rate brachytherapy fractionation schedules in the treatment of cervical cancerIs there an optimal fractionation schedule?
Int J Radiat Oncol Biol Phys
(1999) - et al.
Pretreatment and treatment factors associated with improved outcome in squamous cell carcinoma of the uterine cervixA final report of the 1973 and 1978 patterns of care studies
Int J Radiat Oncol Biol Phys
(1991) - et al.
American Brachytherapy Society survey of brachytherapy practice for carcinoma of the cervix in the United States
Gynecol Oncol
(1999) - et al.
Dose and volume specification for reporting gynaecological brachytherapyTime for a change
Radiother Oncol
(2001)
Survey of the use of the ICRU 38 in recording and reporting cervical cancer brachytherapy
Radiother Oncol
The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix
Int J Radiat Oncol Biol Phys
The American Brachytherapy Society recommendations for brachytherapy of soft tissue sarcomas
Int J Radiat Oncol Biol Phys
New gynecologic cancer staging
Gynecol Oncol
Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervixA Gynecologic Oncology Group study
Gynecol Oncol
Stage IA carcinoma of the cervix revisited
Obstet Gynecol
Cervical conization as definitive therapy for early invasive squamous carcinoma of the cervix
Gynecol Oncol
Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer
Gynecol Oncol
Small bowel obstruction following radical hysterectomyRisk factors, incidence and operative findings
Gynecol Oncol
Randomized study of radical surgery versus radiotherapy for stage IB-IIA cervical cancer
Lancet
Surgical management of early invasive cervical cancer
Clin Obstet Gynecol
Surgical predictors of para-aortic metastases in early stage cervical carcinoma
Gynecol Oncol
Heuristically derived tumor burden score as a prognostic factor for stage IIIB carcinoma of the cervix
Int J Radiat Oncol Biol Phys
Randomized study of preoperative radiation and surgery or irradiation alone in the treatment of stage IB and IIA carcinoma of the uterine cervix. A final report
Gynecol Oncol
Stage IB-IIA-B carcinoma of the cervix 6 cm in diameter managed with irradiation. Is adjuvant hysterectomy beneficial?
Int J Radiat Oncol Biol Phys
Carcinoma of the intact uterine cervix, stage IB through IIA-B, 6 cm in diameterIrradiation alone versus preoperative irradiation and surgery
Int J Radiat Oncol Biol Phys
Bulky endocervical carcinomaA 23-year experience
Int J Radiat Oncol Biol Phys
A review of prognostic factors in early stage carcinoma of the cervix and implications for treatment strategy
Eur J Obstet Gynecol Reprod Biol
Is pelvic radiation therapy beneficial in postoperative management of stage IB squamous cell carcinoma of the cervix with pelvic node metastasis treated by radical hysterectomy and pelvic lymphadenectomy? A report from presidential panel at the 1979 Annual Meeting of the Society of Gynecologic Oncologists
Gynecol Oncol
Lymph node metastasis carcinoma of the cervix, stage IB and IIAImplications for prognosis and treatment
Gynecol Oncol
Value of adjuvant whole pelvis irradiation after Wertheim hysterectomy for early stage squamous cell carcinoma of the cervix with pelvic node metastasisA matched control study
Gynecol Oncol
A prospective surgical pathologic study of stage I squamous cell carcinoma of the cervixA Gynecologic Oncology Group study
Gynecol Oncol
A randomized trial of pelvic radiation therapy versus no further therapy in select patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomyA GOG study
Gynecol Oncol
Carcinoma of the cervixPatterns of care studies. Review of 1978, 1983, and 1988–1989 surveys
Int J Radiat Oncol Biol Phys
Patterns and sites of failure in cervix cancer treated in the USA in 1978
Int J Radiat Oncol Biol Phys
Technically accurate intracavitary insertions improve pelvic control and survival among patients with locally advanced carcinoma of the uterine cervix
Gynecol Oncol
Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy
Int J Radiat Oncol Biol Phys
Adverse effect of treatment prolongation in cervical carcinoma
Int J Radiat Oncol Biol Phys
The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiationA patterns-of-care study
Int J Radiat Oncol Biol Phys
Uterosacral space involvement in locally advanced carcinoma of the uterine cervix
Int J Radiat Oncol Biol Phys
Radiation therapy for carcinoma of the cervix with positive para-aortic lymph nodes
Int J Radiat Oncol Biol Phys
Dose-volume analysis and the prevention of radiation sequelae in cervical cancer
Radiother Oncol
A three-dimensional applicator system for carcinoma of the uterine cervix
Int J Radiat Oncol Biol Phys
Maximum and mean bladder dose defined from ultrasonography. Comparison with the ICRU reference in gynaecological brachytherapy
Radiother Oncol
Pelvic lymphadenectomy following radiation in cervical carcinoma
Am J Obstet Gynecol
Iliac lymphadenectomy with irradiation in the treatment of cancer of the cervix
Am J Obstet Gynecol
Radiotherapy of carcinoma of the cervix following simple hysterectomy
Am J Obstet Gynecol
Iridium-192 transperineal interstitial brachytherapy for locally advanced or recurrent gynecological malignancies
Int J Radiat Oncol Biol Phys
Interstitial therapy of perineal and gynecological malignancies
Int J Radiat Oncol Biol Phys
A multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies
Int J Radiat Oncol Biol Phys
Cited by (122)
The role of physics in modern radiotherapy: Current advances and developments
2022, Photophysics and Nanophysics in TherapeuticsLow-Dose-Rate versus High-Dose-Rate intracavitary brachytherapy in cervical cancer - Final Results of a Phase III randomized trial
2021, BrachytherapyCitation Excerpt :Radical Radiation therapy including external beam radiation therapy (EBRT) and brachytherapy is vital for non-surgical treatment of cervical cancer. (1,2)
Vaginal dose-surface maps in cervical cancer brachytherapy: Methodology and preliminary results on correlation with morbidity
2021, BrachytherapyCitation Excerpt :3 complications (2). A generally accepted dose specification method, in line with the American Brachytherapy Society recommendations (3), was to prescribe to Point A while limiting the dose to the vaginal mucosa to <140–150% of Point A dose (4, 5). More recent studies reported on vaginal dose-volume histograms (DVHs) and correlation with morbidity.
Relative dose intensity and overall treatment time in older patients with cervical cancer treated with concurrent chemoradiotherapy
2021, Journal of Geriatric OncologyVaginal dose de-escalation in image guided adaptive brachytherapy for locally advanced cervical cancer
2016, Radiotherapy and Oncology