Treatment of Carcino ma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron

Suh, Chang Ok; Kim, Gwi Eon; Loh, John J K

Abstract

From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 356 were treated with a high-dose-rate (HDR), remote-controlled, afterloading intracavitary irradiation (ICR) system using a cobalt source (Ralstron), and 168 patients received a low-dose-rate (LER) ICR using a radium source. External beam irradiation with a total dose of 40-50 gy to the whole pelvis followed by intracavitary irradiation with a total dose or 30-39 gy in 10-13 fractions to point A was the treatment protocol ICR was given three times a week with a dose of 3 gy per fraction. Five-year actuarial survival rates in the HER-ICR group were 77.6% in stage IB (N=20), 68.2% in stage II (N=182), and 50.9% in stage III (N=148). In LDR-ICR group, 5-year survival rates were 87.5% in stage IB (N=22), 66.3% in stage II (N=91), and 55.4% in stage III (N-52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in 3.7% of the HDR-ICR group and 8.4% of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was 1.4% in the HDR-ICR group and 2.4% in the LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on an outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients to be treated. In order to tachieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICRand optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol study with different treatment regimens.