Cervical cancer: HDR brachytherapy effective with less toxicity

  • Lin AJ & al.
  • Brachytherapy
  • 14 Jan 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with newly diagnosed cervical cancer receiving chemotherapy, local control rates (LCR) and cancer-specific survival (CSS) were similar with low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy.
  • International Federation of Gynecology and Obstetrics stage III-IVA showed a significant association with worse LCR.
  • HDR brachytherapy was associated with reduced late grade ≥3 bowel/bladder toxicities.

Why this matters

  • Findings suggest increased adoption of HDR brachytherapy, even with concurrent chemotherapy.
  • Poor local control and higher toxicity in patients with stage III-IVA disease need attention.

Study design

  • 609 patients with newly diagnosed cervical cancer (stage IB1-IIB, 457; stage III-IVA, 152) disease received brachytherapy.
  • 88% of patients received concurrent cisplatin.
  • Funding: None disclosed.

Key results

  • 505 patients received HDR brachytherapy.
  • Median follow-up, 9.4 years.
  • At 5 years, LDR vs HDR brachytherapy showed statistically similar LCR (89% vs 86%; P=.24) and CSS (66% vs 69%; P=.50).
  • Stage III-IVA showed a significant association with worse LCR (HR, 2.4; P=.004).
  • At 5 years, late grade ≥3 bowel/bladder adverse event rate was higher with LDR brachytherapy overall (27% vs 12%; P=.007) and in stage III-IVA patients (47% vs 15%; P=.03) after adjusting for tumor recurrences.
  • Propensity-matched analysis: at 5 years, no difference was seen in LCR (P=.26), CSS (P=.19), and grade ≥3 bowel/bladder toxicities (P=.44).

Limitations

  • Retrospective study. 

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