High-dose rate brachytherapy in the treatment of carcinoma of uterine cervix: twenty-year experience with cobalt after-loading system.

This retrospective analysis aims to report results of patients with cancer of uterine cervix treated with external-beam radiotherapy (EBR) and high-dose rate (HDR) brachytherapy, using manual treatment planning. From 1975 to 1995, 237 patients with FIGO stages IIB-IVA and mean age of 54.31 years were treated. EBR dose to the whole pelvis was 50 Gy in 25 fractions. Brachytherapy with HDR after-loading cobalt source (Cathetron) was performed following EBR completion with a dose of 30 Gy in three weekly fractions of 10 Gy to point A. Survival, local control, and genitourinary and gastrointestinal complications were assessed. In a median follow-up of 60.2 months, the 10-year overall and disease-free survival rate was 62.4%. Local recurrence was seen in 12.2% of patients. Distant metastases to the lymph nodes, peritoneum, lung, liver, and bone occurred in 25.3% of patients. Less than 6% of patients experienced severe genitourinary and/or gastrointestinal toxicity that were relieved by surgical intervention. No treatment-related mortality was seen. This series suggests that 50 Gy to the whole pelvis together with three fractions of 10 Gy to point A with HDR brachytherapy is an effective fractionation schedule in the treatment of locally advanced cancer of cervix. To decrease the complications, newer devices and treatment planning may be beneficial.