Combined External and Intracavitary Irradiation in Treatment of Advanced Cervical Carcinomas Predictive Factors for Treatment Outcome and Early and Late Radiation Reactions

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Mordhorst, Louise BohrDepartment of Oncology, Örebro University Hospital, Örebro, Sweden (author)

Combined External and Intracavitary Irradiation in Treatment of Advanced Cervical Carcinomas Predictive Factors for Treatment Outcome and Early and Late Radiation Reactions

Article/chapterEnglish2014

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Lippincott Williams & Wilkins,2014
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LIBRIS-ID:oai:DiVA.org:oru-56655
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-56655URI
https://doi.org/10.1097/IGC.0000000000000208DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Objective: The objective of this study was to find out predictive factors of tumor control as well as acute and late radiation reactions in treatment of advanced cervical carcinomas.Methods: In a series of 134 primary cervical carcinomas in International Federation of Gynecology and Obstetrics stages I to IV treated with combined external pelvic and intraluminal cervical-vaginal brachytherapy, predictive and prognostic factors were analyzed with regard to tumor control, recurrences, survival data, and adverse effects. Concomitant chemotherapy was given to 48 patients (35.8%). The external beam therapy was given with a 4-field technique (50-60 Gy) and brachytherapy was given with a high-dose rate (iridium-192) afterloading technique using a ring applicator set. A computed tomographically based 3-dimensional dose-planning system was used for the external beam therapy and for the brachytherapy planning. The mean age of the patients was 65 years. A total of 110 tumors were squamous cell carcinomas and 24 were adenocarcinomas or adenosquamous carcinomas. A total of 111 tumors were in International Federation of Gynecology and Obstetrics stages I to II; 23 tumors, in stages III to IV.Results: The primary control rate of the complete series was 92.5%. Tumor size, the brachytherapy dose, the combined external and brachytherapy dose, as well as the number of days of interruption (delay) of irradiation were all significant predictive factors for local tumor control. Forty recurrences (30%) were recorded. Early radiation reactions were recorded in 67% (mostly grade 1) and were associated with the widths of the anterior-posterior and lateral pelvic fields. Serious late radiations reactions (grade 3-4) were noted in 11%.Conclusions: The width of the lateral pelvic fields, left point A and B doses, dose to the rectal reference point, as well as asymmetry of the dose distribution were associated with late severe reactions. Prior abdominal and pelvic surgery was also a high-risk factor for late tissue reactions. Concomitant chemotherapy did not increase the risk for acute or late toxicity.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cancer and Oncology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Reproduktionsmedicin och gynekologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Obstetrics, Gynaecology and Reproductive Medicine hsv//eng
Cervical cancer
Radiotherapy
Brachytherapy
Predictive factors
Radiation reactions
Toxicity

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Karlsson, LeifDepartment of Radiation Physics, Örebro University Hospital, Örebro, Sweden (author)
Bärmark, BeritDepartment of Oncology, Örebro University Hospital, Örebro, Sweden (author)
Sorbe, Bengt,1947-Region Örebro län,Department of Oncology, Örebro University Hospital, Örebro, Sweden(Swepub:oru)bse (author)
Department of Oncology, Örebro University Hospital, Örebro, SwedenDepartment of Radiation Physics, Örebro University Hospital, Örebro, Sweden (creator_code:org_t)

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In:International Journal of Gynecological Cancer: Lippincott Williams & Wilkins24:7, s. 1268-12751048-891X1525-1438

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