High Dose Rate Intracavitary Brachytherapy in Locally Advanced Cervical Cancer: A Retrospective Serie Analysis

Abstract

Introduction: The treatment of locally advanced cervical cancer is based on radio chemotherapy followed by brachytherapy. The aim of this study was to evaluate the tolerance and efficacy of image-guided high dose rate (HDR) intracavitarybrachytherapy in a context of limited resources.

Materials and Methods: The clinical and dosimetric data of 60 patients with locally advanced cervical carcinoma treated by concomitant radio-chemotherapy (RCC) follow-up of brachytherapy between January 2019 and December 2023 at the CHU Dalal Jamm in Dakar were retrospectively analyzed. The toxicities of brachytherapy had been evaluated according to the Common Terminology Criteria for Adverse Events V4.0 (CTCAE) criteria. Estimates of overall survival and recurrence-free survival rates were analyzed by the Kaplan-Meier method, comparisons were made with the log-rank test and the cox model, with a 95% confidence interval. The statistical analyses were carried out using SPSS software in version 21.

Results: The average age was 53.8 ± 11.8 years. All patients had locally advanced tumors with FIGO stages IIB and IIIC1 respectively predominant 37.1% each. The median time from completion of external irradiation to brachytherapy was 28 days [0–124]. The dosimetry was in 3D for all patients. The average dose delivered at the high risk CTV (D90) was 82.2 Gy and 71.7 Gy at the low risk CTV. The D2cc (minimum dose received by the most irradiated 2 cm3) were 79.5 Gy for the bladder, 72.1 Gy for the rectum, 55.4 Gy for the sigmoid and 60.1 Gy for the small intestine. The main toxicities of brachytherapy were digestive (16.7%) and genitourinary (33.3%) all grades combined. With a median follow-up of 19.5 months, the evolution was marked by 12 locoregional recurrences (21.4%), 8 metastatic relapses (14.5%) and 6 deaths (10%). Overall survival and local relapse-free survival rates were 76.6% and 64.5% at 3 years, respectively.

Conclusion: Brachytherapy is essential in the optimal management of cervix cancer in advanced stages. Our institutional experience shows that it allows good local control and better overall survival. Interstitial brachytherapy could further improves these results in our context where tumors are advanced to diagnosis.