Reirradiation with high-dose-rate remote afterloading brachytherapy implant in patients with locally recurrent or residual cervical carcinoma.

PURPOSE: To assess the outcome for patients with postradiation locally recurrent or residual cervical malignancies treated with high-dose-rate (HDR) remote afterloading brachytherapy implant. This is a prospective study. MATERIALS AND METHODS: Twenty-two patients with postradiation recurrent cervical carcinomas were treated with HDR interstitial brachytherapy. All of these 22 patients had received some form of radiotherapy prior to implant placement and had biopsy-proven recurrence. Implant dose for these patients was in the range of 12-45 Gy, with a median dose of 25.80 Gy. RESULTS: Overall survival was better for patients in the 'no bad prognostic factor' (NBPF) group than for patients in the 'bad prognostic factor' (BPF) group and this difference was statistically significant. Overall survival was better for patients who had stage II disease before implant placement than for those who had stage III disease and also for patients who had relatively less parametrial disease. Grade 4 complications were seen only in four patients and were within acceptable limits. Multivariate analysis showed that only the BPF variable had a statistically significant effect on survival. CONCLUSION: We conclude that reirradiation with HDR brachytherapy implant in recurrent or residual carcinoma cervix can give a good chance of survival, with acceptable morbidity, if proper selection of patients is done. This treatment should not be done for palliative purposes.

The efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins.

PURPOSE: A retrospective analysis to determine the efficacy of postoperative radiation therapy, in patients of carcinoma of the buccal mucosa and lower alveolus with pathologically verified positive surgical margins (PSM). MATERIALS AND METHODS: Ninety-four patients were analysed, who underwent surgery plus postoperative radiation therapy. Twenty-nine patients (31%) had PSM. Other pathological factors like nodal stage, number of nodes, bone involvement etc. were also analysed. RESULTS: Disease free survival (DFS) of patients with a PSM was significantly worse when compared with those with negative surgical margins (NSM). Poor DFS was also observed for variables like nodal stage, number of nodes and extranodal extension and radiation dose. In multivariate analysis only two variables showed significant impact on DFS, those were surgical margins and number of nodes. CONCLUSION: To conclude in our study median dose of 60 Gy in PSM patients was not able to improve DFS and showed poor results as compared with NSM patients. There is also evidence from other studies, to suggest that post-operative radiation doses upto 60 Gy may not be sufficient to overcome this poor prognostic factor. To overcome this poor prognostic group patients, we in our institution are now employing radiation dose intensification and altered fractionation in an effort to improve our results. In physically fit patients we are trying to administer concomitant chemotherapy along with radiation treatment.