Brachytherapy for stage IIIB squamous cell carcinoma of the uterine cervix: survival and toxicity.

OBJECTIVE: To compare survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate (LDR), high-dose-rate (HDR) brachytherapy and association of HDR and chemotherapy. METHODS: Between 1985 and 2005, 230 patients with FIGO stage IIIB squamous cell carcinoma of the uterine cervix received 4-field pelvic teletherapy at doses between 40 and 50.4 Gy, with a different complementation in each group. The LDRB group, with 42 patients, received one or two insertions of LDR, with Cesium-137, in a total dose of 80 to 100 Gy at point A. The HDR group, 155 patients received HDR in 4 weekly 7 Gy fractions and 9 Gy to 14.4 Gy applied to the involved parametria. The CHT group, 33 patients, were given the same treatment as the HDR group and received 5 or 6 weekly cycles of cisplatin, 40 mg per m(2). RESULTS: The five-year progression-free survival (PFS) was 60% for the HDR group and 45% for the LDR group, and the two-year PFS for the CHT group was 65% (p = 0.02). The five-year Overall Survival (OS) was 65% for the HDR group and 49% for the LDR group. The two-year OS was 86% for the CHT group (p = 0.02). Rectum toxicity grade II was 7% for the LDR group, 4% for the HDR group and 7% for the CHT group that had one case of rectum toxicity grade IV. CONCLUSION: Patients that received HDR had better OS and PFS. The Chemotherapy-HDR association showed no benefit when compared to HDR only. Toxicity rates showed no difference between the three groups.

Brachytherapy for stage IIIB squamous cell carcinoma of the uterine cervix: survival and toxicity / Braquiterapia para carcinoma epidermóide do colo do útero estádio IIIB: sobrevida e toxicidade

OBJECTIVE: To compare survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate (LDR), high-dose-rate (HDR) brachytherapy and association of HDR and chemotherapy. METHODS. Between 1985 and 2005, 230 patients with FIGO stage IIIB squamous cell carcinoma of the uterine cervix received 4-field pelvic teletherapy at doses between 40 and 50.4 Gy, with a different complementation in each group. The LDRB group, with 42 patients, received one or two insertions of LDR, with Cesium-137, in a total dose of 80 to 100Gy at point A. The HDR group, 155 patients received HDR in 4 weekly 7 Gy fractions and 9 Gy to 14.4 Gy applied to the involved parametria. The CHT group, 33 patients, were given the same treatment as the HDR group and received 5 or 6 weekly cycles of cisplatin, 40 mg per m2. RESULTS: The five-year progression-free survival (PFS) was 60 percent for the HDR group and 45 percent for the LDR group, and the two-year PFS for the CHT group was 65 percent (p = 0.02). The five-year Overall Survival (OS) was 65 percent for the HDR group and 49 percent for the LDR group. The two-year OS was 86 percent for the CHT group (p = 0.02). Rectum toxicity grade II was 7 percent for the LDR group, 4 percent for the HDR group and 7 percent for the CHT group that had one case of rectum toxicity grade IV. CONCLUSION: Patients that received HDR had better OS and PFS. The Chemotherapy-HDR association showed no benefit when compared to HDR only. Toxicity rates showed no difference between the three groups.

OBJETIVO: Comparar três diferentes tratamentos para câncer de colo do útero, estádio IIIB: braquiterapia de baixa taxa de dose (LDR), alta taxa de dose (HDR) e associação entre HDR e quimioterapia, quanto à sobrevida e toxicidade. MÉTODOS: Entre 1985 e 2005, 230 pacientes com carcinoma epidermoide de colo do útero estádio IIIB receberam teleterapia pélvica em quatro campos, doses entre 40 e 50.4 Gy, e três complementações diferentes. Grupo LDR, com 42 pacientes, recebeu uma ou duas inserções de LDR, com Césio-137, na dose total de 80 a 100Gy no ponto A. Grupo HDR, 155 pacientes, com HDR em quatro frações semanais de 7 Gy, e 9 Gy a 14.4 Gy nos paramétrios acometidos. Grupo CHT, 33 pacientes, tratadas da mesma forma que o grupo HDR, mais cinco ou seis ciclos semanais de cisplatina, 40 mg por m2. RESULTADOS: A sobrevida livre de progressão em cinco anos (PFS) foi 60 por cento no grupo HDR e 45 por cento no grupo LDR, e a PFS em dois anos para o grupo CHT foi 65 por cento (p = 0.02). A sobrevida global em cinco anos (OS) foi 65 por cento para o grupo HDR e 49 por cento para o grupo LDR. A OS em dois anos foi 86 por cento para o grupo CHT (p = 0.02). Toxicidade retal grau II foi 7 por cento no grupo LDR, 4 por cento no grupo HDR e 7 por cento no grupo CHT, que teve um caso de toxicidade retal grau IV. CONCLUSÃO: Pacientes que receberam HDR tiveram melhores índices de sobrevida. A associação quimioterapia-HDR não mostrou benefício quando comparada com apenas HDR. Os índices de toxicidade não foram diferentes.

Braquiterapia de alta taxa de dose / High dose rate brachytherapy

A braquiterapia de alta taxa de dose utiliza fonte unica de '192 ANT. IND Ir' com atividade nominal inicial de 10Ci em equipamento com controle remoto. Esta tecnica permite que o tratamento seja realizado em regime ambulatorial, sem os inconvenientes da braquiterapia classica, como anestesia geral ou raquidiana, imobilizacao prolongada no leito e exposicao de pessoa a irradiacao. O servico de radioterapia possui cinco protocolos de tratamento em estudo: carcinoma de colo uterino, endometrio, pulmao, esofago e tumores do sistema nervoso central. Desde a instalacao do Micro Selectron HDR foram tratados 90 pacientes, com um total de 257 procedimentos. As aplicacoes sao semanais, perfazendo tres a quatro fracoes. Devido ao pouco tempo de atividade, os resultados sao preliminares, mas perfeitamente comparaveis aos primeiros meses dos tratamenos classicos. Nao tivemos nenhuma complicacao durante os procedimentos ou imediatamente apos. Muitos estudos devem ser realizados para se estabelecer criterios de dose, fracionamento e associacao ideais, a fim de se alcancar um alto nivel de taxa terapeutica.