PURPOSE: To compare the effectiveness and safety of once; versus twice-week
ly high-dose-rate (HDR) brachytherapy for cervical cancer.
MATERIALS AND METHODS: From 1980 to 1997, 124 consecutive previously untrea
ted patients with cervical cancer were treated with externa-beam irradiatio
n (50 Gy) and HDR brachytherapy. Clinical stages were 1, 4 (3%) patients II
, 51 (41%); III, 64(52%); and IV,5(4%). From 1980 to 1992, 74 patients (gro
up A) were treated with HDR brachytherapy once weekly (about three fraction
s of 7 Gy each to point A [2 cm superior and 2 cm lateral to the inferior e
nd of the intrauterine radioactive source]), while from 1992 to 1997, 50 pa
tients (group B) were treated twice weekly (about six fractions of 4.5 Cy-e
ach to point-A).
RESULTS: Overall survival rate at 5 years was 65.2% in group A and 65.3% in
group B (P=.96). Local recurrence-free survival rate at 5 years was 69% (5
1 of 74 patients) in group A and 90% (45 of 50 patients) in group B (P<.001
).The rate of grade 2 (moderate) and grade 3 (severe) complications was sig
nificantly lower in group B (6% vs 32% in group A, P <.001). At multivariat
e analysis, the variables significantly associated with increased local-reg
ional recurrence rates were having stage III-IV lesions (P =.04) and with f
ewer than six sessions of HDR brachytherapy P=.02).
CONCLUSlON: The twice-weekly HDR regimen may improve the local control rate
with fewer complications.