A comparison of manual and remote afterloading in the treatment of carcinoma of the cervix: increasing dose rate with a flexible applicator.

A historical cohort design was used to assess the effect of introducing a remote afterloading system with a flexible applicator for the intracavitary treatment of cervical cancer. One hundred and sixty-eight patients treated for the 5 years prior to its introduction were compared to 84 patients treated for the first 3 years of its use. Patients were comparable with respect to age and stage. Treatment policies and techniques remained the same during the study period. Average dose rate to point A increased from 0.46 Gy/hr to 0.67 Gy/hr. The 3-year actuarial survival was equivalent between the two treatment modalities: 67.7% (manual), and 60.6% (remote). Patterns of local recurrence and distant failure were also equivalent between the two groups. Severe complication rates were comparable (8.3% manual, 6.3% remote) despite the increase in dose rate, confirming that the remote afterloading system can be safely adapted to a flexible applicator. The introduction of the remote afterloading system resulted in a 72% reduction in radiation exposure to staff.

Pelvic radiation therapy for gynecologic malignancy in geriatric patients.

Thirty-one patients, aged 75 years or older, who received pelvic radiation therapy as part of primary treatment for a gynecologic malignancy, were reviewed. Ten patients (32%) failed to complete their treatment and 4 patients (13%) died of treatment-related complications. The treatment-related complications were independent of increasing age, but did correlate closely with the patients' pretreatment ECOG performance status. Ten patients with performance levels of 2 or higher had a mortality rate of 30%, while 70% failed to complete treatment. Treatment fractions of greater than 220 cGy per day also resulted in unacceptably high complication rates. Alternative treatment formats should be considered in geriatric patients with poor initial performance levels.