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HDR and MDR intracavitary treatment for carcinoma of the uterine cervix

Intrakavitäre HDR-und MDR-Radiotherapie bei der Behandlung des Zervixkarzinoms. Eine prospektiv randomisierte Studie

A prospective randomized study

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Abstract

Aim

Treatment of carcinoma of the uterine cervix by remote afterloading brachytherapy has been accompanied with new isotopes having dose rates different from the classical low-dose rate (LDR) radium source. The dose rate conversion factor from LDR to high-dose rate (HDR) found to be around 0.54 in most studies. As regards medium-dose rate (MDR) brachytherapy, the published data are very few and the experience is still short. In this study the experience of Osaka University Hospital with micro-HDR-Selectron and Selectron-MDR, as a preliminary report of the clinical trial, is presented.

Patients and Method

From August 1991 through April 1993, a total of 45 patients with carcinoma of the uterine cervix were randomly allocated to either microSelectron-HDR or Selectron-MDR at the Osaka University Hospital. As regards HDR, dose to point A was adjusted to 32 Gy (for stages I and II), 30 Gy/4 fractions, and 22.5 Gy/3 fractions, for stages III, and IV, respectively. The corresponding values in case of MDR were 35.6, 34 Gy/4 fractions, and 25.5 Gy/3 fractions. External irradiation, according to the stage, was the same in the 2 groups. Nucletron Planning System (NPS) was used for pre-treatment dose calculation at point A, rectal and bladder wall. The dose rate at point A ranged from 24 to 75.6 cGy/min for the HDR group, while for the MDR group ranged among 174.8 to 229.6 cGy/h.

Results

The 3-year survival and loco-regional control rates for both modalities were nearly equivalent (62% and 67% for HDR and 68% and 74% for MDR). The cumulative rectal and bladder complication rates were the same in both groups (29% at 3 years), with only 1 patient (MDR-group) developed grade 3 rectal and bladder complication. In this study, point A dose rate correction factor from LDR to HDR was 0.53 and 0.6 from LDR to MDR.

Conclusion

From the previous reports from Osaka University Medical School, as well as others, HDR was proposed as an alternative to LDR brachytherapy for treatment of carcinoma of the uterine cervix. In this report, Selectron-MDR was nearly equivalent to the microSelectron-HDR as regards survival and loco-regional control rates as well as radiation-induced complication. This is a preliminary report, and the study still needs larger number of patients, and longer follow-up period.

Zusammenfassung

Ziel

Die Therapie des Zervixkarzinoms mittels Afterloading-Brachytherapie wird neuerdings mit neuen Isotopen durchgeführt, die andere Dosisraten haben als die klassischen LDR-Radiumquellen. Der Konversionsfaktor der Dosisrate vom LDR-zum HDR-Verfahren wurde in den meisten Studien mit 0,54 angegeben. Bezogen auf die MDR-Brachytherapie, sind die veröffentlichten Daten spärlich und der klinische Erfahrungshorizont kurz. In dieser Studie werden die klinischen Erfahrungen der Osaka Universitätsklinik mit dem HDR-microSelectron und MDR-Selectron vorgestellt.

Patienten und Methode

Von August 1991 bis April 1993 wurden insgesamt 45 Patientinnen mit Zervixkarzinom randomisiert für eine microSelectron-HDR-oder Selectron-MDR-Brachytherapie. Für die HDR-Brachytherapie wurde die Dosis am Punkt A mit 32 Gy in vier Fraktionen (Stadium I und II), 30 Gy in vier Fraktionen (Stadium III) und 22,5 Gy in drei Fraktionen (Stadium IV) festgelegt. Die entsprechenden Werte lagen bei der MDR-Brachytherapie bei 35,6 Gy und 34 Gy in vier Fraktionen bzw. 25,5 Gy in drei Fraktionen. Die extreme Radiotherapie war in Anpassung an das Stadium für beide Gruppen gleich. Das Nucletron-Planungssystem (NPS) wurde für die Kalkulation der Vorbestrahlungsdosis am Punkt A sowie an der Rektum-und Blasenwand verwendet. Die Dosisrate am Punkt A variierte von 24 bis 75,6 cGy/min bei der HDR-Gruppe und zwischen 174,8 und 229,6 cGy/h bei der MDR-Gruppe.

Ergebnisse

Die Drei-Jahres-Überlebensrate sowie lokoregionale Kontrollrate war bei beiden Bestrahlungsgruppen gleich (62% und 67% bei HDR; 68% und 74% bei MDR). Die kumulativen Komplikationsraten für Rektum und Blase waren ebenfalls gleich (29%); nur ein Patient (MDR-Gruppe) entwickelte Grad-3-Komplikationen an Blase und Rektum. In dieser Studie betrug der Punkt-A-Dosis-Korrekturfaktor von LDR nach HDR 0,53 und von LDR nach MDR 0,6.

Schlußfolgerung

Ausgehend von früheren Berichten der Osaka Universitätsklinik sowie anderen Berichten, wurde die HDR-Brachytherapie als Alternative zur LDR-Brachytherapie bei der Behandlung des Zervixkarzinoms vorgeschlagen. Im vorliegenden Bericht zeigten sich nahezu äquivalente Überlebens-und lokoregionale Komplikationsraten sowie strahlenbedingte Komplikationen für das Selectron-MDR-und das microSelectron-HDR-Verfahren. Dieser vorläufige Bericht wird jedoch noch größere Patientenzahlen und eine längere Nachbeobachtungszeit bis zur endgültigen Beurteilung benötigen.

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Authors and Affiliations

  1. Department of Radiation Oncology, Biomedical Research Center, Osaka University Medical School, 2-2 Yamadaoka, 565, Suita, Osaka, Japan

    M. El-Baradie, To. Inoue, Ta. Inoue, S. Murayama, J. T. Tang, H. Yamazaki & N. Fournier-Bidoz

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  1. M. El-Baradie
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  2. To. Inoue
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  3. Ta. Inoue
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El-Baradie, M., Inoue, T., Inoue, T. et al. HDR and MDR intracavitary treatment for carcinoma of the uterine cervix. Strahlenther. Onkol. 173, 155–162 (1997). https://doi.org/10.1007/BF03039274

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