CT-guided 125I interstitial brachytherapy for pelvic recurrent cervical carcinoma after radiotherapy
Authors Tong L, Liu P, Huo B, Guo Z, Ni H
Received 13 April 2017
Accepted for publication 1 June 2017
Published 17 August 2017 Volume 2017:10 Pages 4081—4088
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Dr Chiung-Kuei Huang
Lina Tong,1 Ping Liu,1 Bin Huo,2 Zhi Guo,1 Hong Ni1
1Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China; 2Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China
Objective: This retrospective study aimed to evaluate the feasibility, safety, and clinical efficacy of computed tomography (CT)-guided 125I seed interstitial brachytherapy for pelvic recurrent cervical cancer in patients with a history of pelvic radiotherapy.
Methods: From March 2011 to December 2015, 35 pelvic recurrent lesions (33 patients) were reirradiated using this type of salvage therapy. The medical history, dose–volume histogram parameters, complications, local control, overall survival (OS), and affected factors were analyzed.
Results: All patients were followed-up until expiration, and the median duration of follow-up was 16 months. The 1-, 3-, 6-, 12-, and 18-month local control rates were 84.5%, 74.2%, 60.0%, 55.5%, and 33.3%, respectively. The symptoms significantly improved after implantation. The median local tumor progression-free survival (LTPFS) and OS times were 7 months (range, 1–19 months) and 12 months (range, 2–42 months), respectively. The 1- and 2-year OS rates were 65.5% and 43.6%, respectively. In univariate analysis, a good performance status, a tumor diameter <4 cm, an interval time from last radiotherapy to seed implantation longer than 6 months and D90 (dose delivered to 90% of the target volume) ≥130 Gy were prognostic factors for LTPFS. Cox proportional hazards regression analysis revealed that tumor size and D90 were independent factors affecting LTPFS (P=0.033, hazard ratio [HR] =3.357, 95% CI =1.105, 10.212; P=0.035, HR =2.766, 95% CI =1.072, 10.212). Good performance status was identified as an independent factor affecting OS (P=0.001, HR =0.086, 95% CI =0.019, 0.387). Two patients showed grade 3–4 toxicity – 1 patient had rectovaginal fistula and 1 patient had incomplete intestinal obstruction – and 3 cases showed seed migration in our analysis. No grade 5 events occurred.
Conclusion: Reirradiation with CT-guided 125I seed interstitial brachytherapy is a safe, effective, and minimally invasive method to treat patients with recurrent cervical cancer after radiotherapy.
Keywords: 125I seed, brachytherapy, recurrent, cervical cancer
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