Abstract
Purpose
To report outcomes and identify predictors of toxicity in patients undergoing reirradiation
with interstitial brachytherapy (ISBT) for recurrent cancers of the female reproductive
tract.
Methods and Materials
Twenty-one patients received ISBT performed using 192Ir sources (10 low dose rate and 11 high dose rate) at our institution between 2009
and 2013. Demographic, disease specific, treatment, toxicity, and outcome data were
collected. Kaplan–Meier and proportional hazard models were used to estimate survival
and logistic regression to model toxicity. A least absolute shrinkage and selection
operator penalty was used to identify relevant predictors of outcome and toxicity.
Results
Eleven patients had uterine cancer, 7 patients had cervical cancer, and 3 patients
had vulvar cancer. One-year actuarial freedom from local–regional failure, progression-free
survival (PFS), and overall survival were 71.5%, 66.0%, and 82.2%, respectively. Tumor
size was a significant predictor of worse PFS and overall survival (1 cm increase
in tumor size = hazard ratio [HR], 1.61; 95% confidence interval [CI]: 1.16, 2.62
for PFS; HR, 2.02; 95% CI: 1.21, 3.38). Grade 3 or higher vaginal, urinary, and rectal
toxicity occurred in 28.5%, 9.5%, and 19% of patients, respectively. Urethra D0.1cc predicted for grade 2 or higher urinary toxicity (one equivalent dose in 2 Gy fraction
increase = HR, 1.156; 95% CI: 1.001, 1.335).
Conclusions
Reirradiation with ISBT is both safe and effective. In patients with recurrent cancer,
urethra D0.1cc predicts for increased urinary toxicity. Increased tumor size is a negative prognostic
factor in patients receiving ISBT for cancer recurrence.
Keywords
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Article Info
Publication History
Published online: June 16, 2015
Accepted:
May 18,
2015
Received in revised form:
April 14,
2015
Received:
March 16,
2015
Footnotes
Disclosures: No conflicts of interest exist.
Identification
Copyright
© 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
