ABSTRACT
Cervical cancer is a common malignancy in women. Surgery and radiotherapy are the main therapeutic approaches. The recurrence rate of cervical cancer is high and the prognosis is relatively poor. Recurrent cervical cancer can be classified into the central pelvic, lateral pelvic and extra-pelvic recurrence. The management of recurrent cervical cancer mainly depends on previous therapeutic approaches and the recurrence site. Surgical resection is the optimal option for patients who have no history of radiotherapy, if feasible, chemoradiotherapy±brachytherapy can be considered. Patients with central pelvic recurrence after radiotherapy are suitable candidates for pelvic exenteration±intraoperative radiotherapy. However, the indications are highly selective, the incidence of postoperative complications is high and the quality of life is poor. Patients with lateral pelvic recurrence after radiotherapy could be treated by re-radiotherapy or chemotherapy. However, the incidence of serious side effects of re-radiotherapy is higher than that of the initial radiotherapy. The indications for stereotactic body radiotherapy are limited and the surgical skill of the surgeons is demanding. In recent years, radiotherapy technology has become more precise. Image-guided brachytherapy, such as high-dose-rate interstitial brachytherapy and radioactive 125I seed implantation, has achieved high efficacy and safety, which may provide new treatment options for recurrent cervical cancer. In this article, research progress on brachytherapy for recurrent cervical cancer was summarized and reviewed.
ABSTRACT
Objective@#To investigate the safety and efficacy of 3-dimensional (3D) printing noncoplanar templates (PNCT) assisted computer tomography (CT) guided radioactive125I seed implantation (RISI) for the treatment of recurrent cervical carcinoma (RCC) after external beam radiotherapy (EBRT). @*Methods@#A total of 103 patients with inoperable post-EBRT RCC were included in this retrospective study. A total of 111 lesions received RISI. Eight lesions were at the pelvic center, 75 lesions were at the pelvic lateral, and 28 lesions were extra-pelvic metastasis. The median prescription dose was 120 Gy. The primary end points were adverse events and local control (LC), and the secondary end points were overall survival (OS) and progression-free survival. @*Results@#Grade 2 adverse events of acute nausea, diarrhea, and pollakiuria occurred in 1, 2, and 1 patient, respectively. One patient suffered from grade 3 acute proctitis. Late toxicity was observed in 2 patients with rectovaginal fistula. No grade 5 toxicity occurred. The 3-year LC and OS rates were 75.1% and 20.8%, respectively. The median OS was 17 months. The multivariate analysis showed that the minimum dose received by the “hottest” 90% of the gross tumor volume (D 90 ) ≥130 Gy, squamous cell carcinoma, hemoglobin ≥80 g/L and good short-term efficacy (complete response or partial response) were independent predictors of LC and OS (all p<0.05). @*Conclusions@#3D-PNCT assisted CT-guided RISI is a safe, effective, and minimally invasive modality for RCC. The hemoglobin level, pathological type, dose distribution and short-term efficacy are considered as independent factors for clinical outcomes.