Long-term results of 3-D brachytherapy treatment in locally advanced cervical cancer
Long-term results of 3-D brachytherapy treatment in locally advanced cervical cancer
Yazar: Yetmen Doğan, Özlem; Eren, Makbule
Dergi: Cumhuriyet Tıp Dergisi, Vol. 41 No. 3, 2019
Anahtar kelimeler: Health Care Administration ; Sağlık Kurumları Yönetimi ; Cervical cancer,3D brachytherapy,radiotherapy

In many advanced studies, image-guided 3D brachytherapy (BT) treatment hasbeen shown to improve survival and reduce treatment-related toxicity in locallyadvanced cervical cancer. In this study, long-term treatment results, riskyorgan doses and toxicity results of patients who were admitted to our clinicwith the diagnosis of cervical cancer and treated with 3D brachytherapy wereexamined.Between 2012 and 2015, 152 inoperable cervical cancers were admitted, andlong-term (> 12 months) follow-up of our clinic107 cases of inoperablecervical cancer was included in the study. After pelvic radiotherapy, pelvicMRI was performed, and target volumes were determined on CT. Volumes defined bythe GEC-ESTRO guideline were, Gross tumor volume (GTV); residual tumor volumeafter external RT, High-risk clinical tumor volume (HRCTV); entire cervix andresidual lesion, Intermediate-risk clinical tumor volume (IRCTV) low-riskvolume and rectum, sigmoid and bladder contouring as risky organs,respectively. 3D brachytherapy treatment was performed with the microselectrondevice of 192 high-dose-rate (HDR) Ir 192 source. The median age was 53 years, and the median follow-up was 45 months. Allpatients were diagnosed by biopsy, and 81.9% of these patients were diagnosedas squamous cell carcinoma. According to the stages;IB1 was 2 (2%), II was 65(61%), III was 31 (29%), and IV was 9 (8%). 96% of the patients receivedcisplatin-based chemotherapy with pelvic 3 D RT. When 3D RT doses of allpatients were examined; Median HRCTV was calculated as 90% 6 Gy, EQD2 value84.7 Gy, IRCTV 95% 3.03 Gy. When we look at risky organ doses; The medianrectum 2cc 2.4Gy, EQD2 58.4Gy value, median bladder 2cc 3.52Gy, EQD2 value was68.8 Gy, median sigmoid 2cc 2.60 Gy, EQD2 value was found to be 60.3 Gy. Duringthe follow-up period, 4 patients had local recurrence, 11 patients had bothlocal and distant metastasis, and 21 patients had only distant metastasis. Theoverall survival rate of 3 and 5 years was 78.1% and 72.2%. The 3 and 5-yearlocal control rates were 87.4% and 77.3%, respectively. The survival rates of 3and 5 years without distant metastasis were 66.5% and 61.2%. Rectovaginalfistula developed in 5 patients as late side effects and tumor progression wasfound in three of these patients.In the treatment of locally advanced cervical cancer 3D BRT, the volumesdefined by the GEC-ESTRO guidance are individual. Thanks to the development ofimaging techniques during the treatment of these volumes, the survival rateshave increased compared to the previous series, and a shallow rate of GIS andGUS side effects are observed.

In many advanced studies, image-guided 3D brachytherapy (BT) treatment hasbeen shown to improve survival and reduce treatment-related toxicity in locallyadvanced cervical cancer. In this study, long-term treatment results, riskyorgan doses and toxicity results of patients who were admitted to our clinicwith the diagnosis of cervical cancer and treated with 3D brachytherapy wereexamined.Between 2012 and 2015, 152 inoperable cervical cancers were admitted, andlong-term (> 12 months) follow-up of our clinic107 cases of inoperablecervical cancer was included in the study. After pelvic radiotherapy, pelvicMRI was performed, and target volumes were determined on CT. Volumes defined bythe GEC-ESTRO guideline were, Gross tumor volume (GTV); residual tumor volumeafter external RT, High-risk clinical tumor volume (HRCTV); entire cervix andresidual lesion, Intermediate-risk clinical tumor volume (IRCTV) low-riskvolume and rectum, sigmoid and bladder contouring as risky organs,respectively. 3D brachytherapy treatment was performed with the microselectrondevice of 192 high-dose-rate (HDR) Ir 192 source. The median age was 53 years, and the median follow-up was 45 months. Allpatients were diagnosed by biopsy, and 81.9% of these patients were diagnosedas squamous cell carcinoma. According to the stages;IB1 was 2 (2%), II was 65(61%), III was 31 (29%), and IV was 9 (8%). 96% of the patients receivedcisplatin-based chemotherapy with pelvic 3 D RT. When 3D RT doses of allpatients were examined; Median HRCTV was calculated as 90% 6 Gy, EQD2 value84.7 Gy, IRCTV 95% 3.03 Gy. When we look at risky organ doses; The medianrectum 2cc 2.4Gy, EQD2 58.4Gy value, median bladder 2cc 3.52Gy, EQD2 value was68.8 Gy, median sigmoid 2cc 2.60 Gy, EQD2 value was found to be 60.3 Gy. Duringthe follow-up period, 4 patients had local recurrence, 11 patients had bothlocal and distant metastasis, and 21 patients had only distant metastasis. Theoverall survival rate of 3 and 5 years was 78.1% and 72.2%. The 3 and 5-yearlocal control rates were 87.4% and 77.3%, respectively. The survival rates of 3and 5 years without distant metastasis were 66.5% and 61.2%. Rectovaginalfistula developed in 5 patients as late side effects and tumor progression wasfound in three of these patients.In the treatment of locally advanced cervical cancer 3D BRT, the volumesdefined by the GEC-ESTRO guidance are individual. Thanks to the development ofimaging techniques during the treatment of these volumes, the survival rateshave increased compared to the previous series, and a shallow rate of GIS andGUS side effects are observed.