Computed Tomography-Based Interstitial Brachytherapy for Recurrent Cervical Carcinoma in the Vaginal Apex

To determine the factors influencing the outcomes of patients with recurrences post-hysterectomy for cervical cancers treated with external beam radiotherapy (EBRT) and interstitial brachytherapy. This prospective study accrued 90 patients between October 2008 and May 2014. All patients had had a pr...

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Bibliographic Details
Published in:Clinical oncology (Royal College of Radiologists (Great Britain)) 2022-01, Vol.34 (1), p.e1-e6
Main Authors: Engineer, R., Chopra, S., Shukla, R., Mahantshetty, U., Phurailatpam, R., Ghadi, Y., Gupta, S., Shrivastava, S.K.
Format: Article
Language:English
Subjects:
Brachytherapy
Carcinoma, Squamous Cell
Female
Humans
Interstitial brachytherapy
Neoplasm Recurrence, Local - radiotherapy
Prospective Studies
Radiotherapy Dosage
recurrent cervical carcinoma
Tomography, X-Ray Computed
Uterine Cervical Neoplasms - diagnostic imaging
Uterine Cervical Neoplasms - radiotherapy
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Summary:To determine the factors influencing the outcomes of patients with recurrences post-hysterectomy for cervical cancers treated with external beam radiotherapy (EBRT) and interstitial brachytherapy. This prospective study accrued 90 patients between October 2008 and May 2014. All patients had had a prior hysterectomy and were diagnosed with recurrent vaginal apex cancers with squamous cell carcinomas. All underwent EBRT of 50 Gy (2 Gy/fraction) using tomotherapy-based image-guided intensity-modulated radiotherapy with concurrent chemotherapy of weekly cisplatin (40 mg/m2) followed by high dose rate interstitial brachytherapy boost of 20 Gy (4 Gy/fraction twice a day). Local relapse, disease-free and overall survival were determined. At a median follow-up of 74 months (4–123 months), 10/90 (11%) patients had local failure as the first site of relapse and 12/90 (13.3%) had first distant relapse. Only one patient had synchronous local and distant relapse. The 7-year local relapse-free, disease-free and overall survival were 87.6, 68.3 and 68.3%, respectively. Grade 2 and 3 rectal toxicity were seen in 5.6 and 3.1% of patients, respectively. Among these, two (2.2%) patients underwent temporary diversion colostomy due to vaginal sigmoid and rectovaginal fistula. Grade 2 and 3 bladder toxicity were seen in 5.6 and 1.1% of patients, respectively. In summary, the lateral disease extent (P = 0.048) and the presence of nodal disease at diagnosis (P = 0.08) had a statistically significant or borderline impact on local relapse without any impact on disease-free survival. Tumour size in itself did not affect overall survival. With the integration of EBRT and interstitial brachytherapy, most vaginal apex recurrences can be salvaged. An excellent local control and survival is achievable using intensity-modulated radiotherapy with image guidance and concurrent chemotherapy followed by high dose rate interstitial brachytherapy. •We studied outcomes in patients with vaginal recurrences after surgery.•The study used IG-IMRT to reduce dose to organs at risk and escalate nodal dose.•Interstitial brachytherapy using perineal template to a dose of 20 Gy/5 fractions.•7-year local relapse-free, disease-free and overall survival were 87.6, 68 and 68%, respectively.•Grade 3 rectal and bladder toxicity were seen in 3.1 and 1.1% of patients, respectively.
ISSN:0936-6555
1433-2981
DOI:10.1016/j.clon.2021.09.012