International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationsHigh-dose-rate Intracavitary Brachytherapy in the Management of Cervical and Vaginal Intraepithelial Neoplasia
Introduction
The death rate from cervical cancer is widely recognized to have decreased following the introduction of mass screening of the population at risk with cytologic smears and the resulting prompt treatment of cervical cancer and cervical intraepithelial neoplasia (CIN). Barron et al. [1]reported that the natural history of mild and moderate dysplasia is significantly different from that of severe dysplasia and carcinoma in situ (CIS) of the cervix, but that the latter share the same natural history and potential to become invasive. Therefore, the authors suggested that CIN grade 3 (CIN-3) includes both severe dysplasia and CIS.
The standard treatment for CIN-3 is cervical conization. The disease in selected patients can be managed by outpatient therapy using either cryotherapy or laser ablation. Hysterectomy has been considered the treatment of choice in the past, but it now appears that this is not always justified. Intracavitary treatment has also been employed in the past for CIS, but it appears no longer to be necessary in primary management, as other techniques have now become available. Irradiation may be used for CIN-3 in patients with medical contraindications to surgery.
Vaginal intraepithelial neoplasia (VAIN) sometimes occurs during the course of follow-up for CIN in patients with posthysterectomy status. The incidence of VAIN after hysterectomy is low; however, these lesions have the potential to progress to invasive cancer. Although the most effective treatment for VAIN is uncertain, irradiation is used for a VAIN lesion involving the vaginal wall after hysterectomy.
The purpose of this study was to assess the effectiveness of high-dose-rate intracavitary brachytherapy (HDR-ICR) in the management of patients with CIN-3 and VAIN-3.
Section snippets
Methods and Materials
This was a retrospective analysis conducted in 20 patients with CIN-3 (n = 14) or with VAIN-3 after CIN-3 (n = 6), managed with HDR-ICR at Kanagawa Cancer Center between April 1983 and July 1993. The patients ranged in age from 40 to 77 years, with mean age of 61.9 years. HDR-ICR were used to treat cervical lesions alone in 13 patients. One patient received HDR-ICR for both CIN-3 and VAIN-3 lesions in the cervix and vagina. Six patients with CIN-3 after hysterectomy received HDR-ICR for
Results
The mean duration of follow-up was 90.5 months (range 13–153). Fourteen women (70%) were alive at the last follow-up with no sign of recurrence.
Discussion
In earlier years of the period in question, a large number of patients with CIN-3 were treated with intracavitary brachytherapy or other radical procedures such as hysterectomy 3, 4, 5, 6, 7. Creasman and Rutledge [4]and Kolstad and Klem [7]compared the recurrence rate of CIS in groups of patients treated with different modalities as the initial treatment. The recurrence rates following radiation therapy that they reported were similar to those obtained following either conization and simple
References (26)
- et al.
Late rectal complication following high dose rate intracavitary brachytherapy in cancer of the cervix
Int. J. Radiat. Oncol. Biol. Phys.
(1995) - et al.
Radiotherapy alone for medically inoperable carcinoma of the cervixStage IA and carcinoma in situ
Int. J. Radiat. Oncol. Biol. Phys.
(1991) The effect of age, gravity, and parity on the location of the cervical squamocolumnar junction as determined by colposcopy
Am. J. Obstet. Gynecol.
(1977)- et al.
Upper vaginectomy for in situ and occult, superficially invasive carcinoma of the vagina
Am. J. Obstet. Gynecol.
(1992) - et al.
Treatment of vaginal carcinoma in situ with the carbon dioxide laser
Am. J. Obstet. Gynaecol.
(1982) - et al.
Definitive radiotherapy for carcinoma of the vaginaOutcome and prognostic factors
Int. J. Radiat. Oncol. Biol. Phys.
(1996) - et al.
Statistical model of the natural history of cervical carcinomaII. Estimates of the transition time from dysplasia to carcinoma in situ
J. Nat. Cancer Inst.
(1970) - et al.
The results of treatment of 4389 cases of preclinical cervical squamous carcinoma
J. Obstet. Gynaecol. Br. Commonw.
(1970) - et al.
Carcinoma in situ of the cervix
Obstet. Gynecol.
(1972) - et al.
Transvaginal roentgen therapy in the conservative management of carcinoma in situ of the cervix
Radiology
(1965)