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AbstractAbstract
[en] Objective: Prognostic factors in cancer of the cervix for patients treated with external beam irradiation (EBR) and low-dose-rate (LDR) brachytherapy have been well characterized. However, despite the increasing use of high-dose-rate (HDR) brachytherapy few studies with adequate patient numbers and follow-up have analysed prognostic factors. This current study investigates pretreatment and treatment factors for their correlation with disease-free survival (DFS) and pelvic control. Materials and Methods: Between September 1985 and December 1994, 181 patients with primary carcinoma of the cervix FIGO stages IB (32), II (65), IIIB (78), and IV (6) received EBR to the whole pelvis (median dose: 48 Gy) followed by 1-6 HDR placements (median: 3). The median brachytherapy dose delivered to point A was 17,5 Gy. Hemoglobin levels were maintained above a level of 11 g/dl during the treatment by transfusion. Patient age ranged from 34 to 84 years (median: 66). The median follow-up time for patients at risk is 69 months (range: 23-140). Parameters analysed to assess their impact on survival, DSF, and pelvic control included patient age, FIGO stage, tumor size (<3 vs ≥3<6 vs ≥6 cm maximum diameter), tumor grade, pretreatment hemoglobin level (< 11 g/dl), total dose to point A, number of HDR fractions, and overall treatment time. Also evaluated was the prognostic significance of enlarged pelvic lymph nodes (≥ 2 cm) noted on pretreatment pelvic CAT-scan. Results: At 5 years actuarial survival, DFS, and pelvic control rates for all patients were 60%, 58% and 67%. The DFS by stage was for IB: 94%, II: 63%, IIIB: 43% and IV:0%; the pelvic control rates were 94%, 66%, 59%, and 0%, respectively. In univariate analysis the prognostic factors identified were FIGO stage (p<0.0003), tumor size (p<0.0001), pretreatment hemoglobin level (p<0.0001), and enlarged pelvic nodes (p<0.0001). Five-year DFS rates for tumors <3, ≥3<6, and ≥6 cm were 97%, 65%, and 24%; patients with initial hemoglobin levels < 11g/dl had a DFS of 26% vs 69% for patients with levels > 11g/dl; and those with enlarged pelvic nodes had a survival of 30% vs 66% for patients without enlarged nodes. The same factors were also prognostically significant for pelvic control. Age, grade, dose, number of HDR placements, and overall treatment time were not of prognostic significance for either DFS or pelvic control. Conclusions: This study confirms that prognostic factors for patients treated with HDR brachytherapy are similar to those reported in previous series that employed LDR brachytherapy and demonstrated the significance of tumor size, pretreatment hemoglobin, and enlarged pelvic nodes in addition to FIGO stage of disease. Future prospective trials should be undertaken to confirm the validity of these factors and to elucidate their therapeutic implications
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S0360301697807055; Copyright (c) 1997 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
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Journal Article
Journal
International Journal of Radiation Oncology, Biology and Physics; ISSN 0360-3016; ; CODEN IOBPD3; v. 39(2,suppl.1); p. 208
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