High dose rate intracavitary brachytherapy for recurrent or residual lesions in the vaginal cuff: results in post-hysterectomy patients with carcinoma of the cervix.

The purpose of this study was to assess the long-term survival, disease control, and complication rates of high dose rate intracavitary brachytherapy (HDR-ICR) alone or combined with external beam irradiation (HDR-ICR + EBRT) in patients with pathologically involved or close surgical margin in the vagina (Group 1) and recurrent lesions in the vaginal cuff (Group 2) following hysterectomy for cervical carcinoma. In Group 1, 10 patients received HDR-ICR only, and 11 patients received HDR-ICR + EBRT with or without paravaginal shielding. In Group 2, 8 patients received HDR-ICR only, and 11 patients received HDR-ICR + EBRT with or without paravaginal shielding. The HDR-ICR dose per fraction planned at the Apical Vaginal Point was 5-6 Gy per week. In Group 1, the 5-year absolute survival rates (AS), disease-free survival rates (DFS), and vaginal control rates (VC) were 81.0%, 76.2%, and 100%, respectively. The 5-year AS was lower in patients with parametrial infiltration or adenocarcinoma. In Group 2, the 5-year AS, DFS, and VC were 73.3%, 77.4% and 88.8%, respectively. The 5-year AS was lower when tumors were larger than 3 cm or infiltrated. Late complications occurred in 10 patients. In all but one patient, the complications were acceptable. All patients with cystitis, ileus, or leg edema received EBRT + HDR-ICR. We recommend a treatment regimen of 25-30 Gy of HDR-ICR alone for Group 1 patients without pathologically high risk of recurrence or Group 2 patients with superficial recurrent lesions, and a treatment regime of 50 Gy whole pelvis EBRT combined with 10-15 Gy HDR-ICR for Group 1 patients with pathologically high risk of recurrence or Group 2 patients with infiltrated recurrent lesions.