Treatment Outcome Of Patients With Advanced Cervical Carcinoma After Concurrent Chemotherapy And External Beam Radiation Therapy Plus High-Dose-Rate (Hdr) Brachytherapy

This is a retrospective study to evaluate the treatment outcome of patients with FIGO stage IIIA-IVB who received concurrent external beam therapy and chemotherapy plus HDR brachytherapy. We reviewed 484 patients with cervical carcinoma who were treated between 2000, when we switched from low-dose-rate (LDR) to HDR brachytherapy, and 2012. We identified 143 patients with FIGO stage IIIA-IVB disease, only 108 of whom had adequate follow up information (IIIA 8, IIIB 77, IVA 6, and IVB 17). Most were treated with pelvic radiation therapy 45-50 Gy with concurrent weekly cisplatinum chemotherapy. This was followed by HDR brachytherapy with tandem and ovoids, receiving 25-35 Gy in 5-6 insertions, twice a week. Six patients received HDR interstitial brachytherapy because of bulky residual disease after external radiation therapy. Some patients also received para-aortic irradiation, mostly because of nodal involvement. The mean age was 47 years old (range 20-87). The mean follow-up was 20 months (range 3-100 months). There were 50 patients who died, mostly of disease with the overall survival rate of 53% (IIIA 63%, IIIB 61%, IVA 33%, and IVB 24%). Forty-one patients, or 38%, were alive without disease (IIIA 50%, IIIB, 43%, IVA 33%, and IVB 12%). Pelvic control rate was 69% (74 patients). Chronic bladder, rectal, vaginal complications (grade >II) and intractable pain were observed in 41 patients, with only 3 patients having fistulas and 2 having colostomy procedures for enteritis. The treatment outcome of advanced cervical carcinoma after concurrent chemotherapy and external radiation therapy plus high-dose-rate (HDR) brachytherapy appears to be similar to that after LDR brachytherapy. The overall outcome is generally poor, especially for those with stage IVA and IVB disease. Even with local pelvic control, most patients still develop regional nodal and distant metastasis. Better systemic chemotherapy is warranted.