Cumhuriyet Medical Journal

Abstract

In many advanced studies, image-guided 3D brachytherapy (BT) treatment has
been shown to improve survival and reduce treatment-related toxicity in locally
advanced cervical cancer. In this study, long-term treatment results, risky
organ doses and toxicity results of patients who were admitted to our clinic
with the diagnosis of cervical cancer and treated with 3D brachytherapy were
examined.

Between 2012 and 2015, 152 inoperable cervical cancers were admitted, and
long-term (> 12 months) follow-up of our clinic107 cases of inoperable
cervical cancer was included in the study. After pelvic radiotherapy, pelvic
MRI was performed, and target volumes were determined on CT. Volumes defined by
the GEC-ESTRO guideline were, Gross tumor volume (GTV); residual tumor volume
after external RT, High-risk clinical tumor volume (HRCTV); entire cervix and
residual lesion, Intermediate-risk clinical tumor volume (IRCTV) low-risk
volume and rectum, sigmoid and bladder contouring as risky organs,
respectively. 3D brachytherapy treatment was performed with the microselectron
device of 192 high-dose-rate (HDR) Ir 192 source.

The median age was 53 years, and the median follow-up was 45 months. All
patients were diagnosed by biopsy, and 81.9% of these patients were diagnosed
as squamous cell carcinoma. According to the stages;IB1 was 2 (2%), II was 65
(61%), III was 31 (29%), and IV was 9 (8%). 96% of the patients received
cisplatin-based chemotherapy with pelvic 3 D RT. When 3D RT doses of all
patients were examined; Median HRCTV was calculated as 90% 6 Gy, EQD2 value
84.7 Gy, IRCTV 95% 3.03 Gy. When we look at risky organ doses; The median
rectum 2cc 2.4Gy, EQD2 58.4Gy value, median bladder 2cc 3.52Gy, EQD2 value was
68.8 Gy, median sigmoid 2cc 2.60 Gy, EQD2 value was found to be 60.3 Gy. During
the follow-up period, 4 patients had local recurrence, 11 patients had both
local and distant metastasis, and 21 patients had only distant metastasis. The
overall survival rate of 3 and 5 years was 78.1% and 72.2%. The 3 and 5-year
local control rates were 87.4% and 77.3%, respectively. The survival rates of 3
and 5 years without distant metastasis were 66.5% and 61.2%. Rectovaginal
fistula developed in 5 patients as late side effects and tumor progression was
found in three of these patients.

In the treatment of locally advanced cervical cancer 3D BRT, the volumes
defined by the GEC-ESTRO guidance are individual. Thanks to the development of
imaging techniques during the treatment of these volumes, the survival rates
have increased compared to the previous series, and a shallow rate of GIS and
GUS side effects are observed.