Carcinoma of the uterine cervix: Twice-versus once-weekly high-dose-rate brachytherapy

PURPOSE: To compare the effectiveness and safety of once; versus twice-weekly high-dose-rate (HDR) brachytherapy for cervical cancer. MATERIALS AND METHODS: From 1980 to 1997, 124 consecutive previously untreated patients with cervical cancer were treated with externa-beam irradiation (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 (group A) were treated with HDR brachytherapy once weekly (about three fractions of 7 Gy each to point A [2 cm superior and 2 cm lateral to the inferior end of the intrauterine radioactive source]), while from 1992 to 1997, 50 patients (group B) were treated twice weekly (about six fractions of 4.5 Cy-each 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% (51 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 significantly lower in group B (6% vs 32% in group A, P <.001). At multivariate analysis, the variables significantly associated with increased local-regional recurrence rates were having stage III-IV lesions (P =.04) and with fewer than six sessions of HDR brachytherapy P=.02). CONCLUSlON: The twice-weekly HDR regimen may improve the local control rate with fewer complications.