High dose rate 60Co remote afterloading irradiation in cancer of the cervix in Haiti, 1977-1984.

From 1977 through 1984, 293 previously untreated patients with biopsy proven carcinoma of the uterine cervix were treated by whole pelvis irradiation and high intensity 60Co remote afterloading (RAL) intrauterine tandem techniques in Haiti. The treatment results were analyzed retrospectively to evaluate the therapeutic results and prognostic factors of a strict protocol involving 40 Gy to the whole pelvis (2 Gy/day, 5 days/week). In addition, on the 5th day of the 3rd week, the first outpatient 60Co remote afterloading intracavitary insertion, delivering 7.5 Gy to point "A" with each insertion, repeated 3 times by a week separation for a total of 4 times. The total TDF for external beam plus RAL was 158 and 175 for early and late effects respectively. One hundred-four patients were evaluable after 1 year or more follow-up, with a median of 26.5 months. No evidence of disease (NED) by Stage at 1 year was: Stage I of 100% (3/3), Stage II of 82% (9/11), Stage III of 80% (47/59), and Stage IV of 58% (18/31). The post-therapeutic complication rate was 7.7%, with no fistulas or requirement of surgical intervention. Those with documented follow-up of at least 2 years (74 patients) had comparable survival to other high dose rate and low dose rate studies. This study shows that outpatient brachytherapy can be carried out without sophisticated and expensive equipment with minimal staff trained in radiation therapy. A detailed description of this outpatient RAL technique and results are described so that this method can be adapted to other developing and industrialized nations where cost containment is becoming a key issue.