ABSTRACT
To evaluate physical profile, application techniques and clinical results of conventional external beam radiotherapy [EBRT] with different dose intracavitary brachytherapy [ICRT]. The role of concurrent cisplatin-based chemo-radiotherapy and HDR interstitial brachytherapy technique was also assessed. A total of 108 patients were prospectively studied, distributed into three treatment groups. Treatment was initiated with EBRT in all treatment groups. Groups I and II patients were divided into 2 subgroups [IA, IB], [IIA, IIB]. Both subgroups were treated by a conventional EBRT schedule, and concurrent cisplatin in group II. This was followed by ICRT either low dose rate [LDR] in subgroups IA, IIA or high dose rate [HDR] ICRT in subgroups IB, IIB. Group III patients received concurrent chemoradiotherapy followed by intertistial HDR brachytherapy. The mean age was 48 year. Vaginal bleeding was the most frequent symptom [84%, 80%, and 89% in groups I, II, and III respectively]. Exocervical lesions were the commonest presentation in groups I and II [70%]. Squamous cell carcinoma was dominant in all therapeutic groups. The clinical results showed complete response [CR] in 78% [group I] and 84% in group II, while in group III, only 61% achieved CR. Notably the associated early and late reactions were reported in group III more than the other two groups. Forty-two month actuarial pelvic/locoregional control rates were achieved in 66%, 77%, and 39% in groups I, II and III respectively [p=0.05]. The utilization of HDR ICRT compared to LDR produced a dramatically improved ability for dose distribution and optimization, not to mention patient convenience. The addition of cisplatinum with conventional EBRT and ICRT [LDR and/or HDR] demonstrated a clear positive impact on initial treatment results and subsequent progression-free and overall survival, with minimal differences in treatment related morbidities compared to radiotherapy alone. The utilization of interstitial rather than ICRT techniques, for patients with generally poor pelvic anatomy, producing more improved dose distribution/optimization, resulted in comparable actuarial 3.5-year cumulative overall survival rate