Patient Characteristics

1. Clinical Outcomes for Tandem and Ring Brachytherapy for Cervix Cancer: The University of Washington Experience Benjamin King, M.D., Christopher Loiselle, M.D., Haleigh Werner, M.D., Thomas Carlson, M.D., and Wui-Jin Koh M.D. Patient Characteristics Purpose Results • Crude local control was 89.9% (125/139) and 3-year actuarial LC was 84.2% • Crude metastasis-free survival was 74.8% (104/139) and 3-year actuarial MFS was 64.6% • Crude overall survival was 84.9% (118/139) while 3-year actuarial OS was 77.8% • Patients with local recurrence had poor prognostic factors such as residual disease according to physical exam after external beam radiation (9 /14), pelvic sidewall invasion (7 of 14), positive pelvic nodes when assessed via surgical sampling or PET (7 of 11). • All recurrences (except one villogladular adenocarcinoma) had moderately or poorly differentiated histologies. • Definitive concurrent cisplatin-based chemo-radiation, is the standard of care for locally advanced carcinoma of the cervix. Brachytherapy is a crucial component of therapy. • There are differing approaches to brachytherapy, including low-dose-rate (LDR) and high-dose-rate (HDR) techniques, as well as the use of more traditional tandem and ovoids (T&O) versus newer tandem and ring (T&R) applicators. • The fixed geometry of T&R allows for greater inter-placement reproducibility, more rapid dosimetry planning, and hence increased patient comfort. • Others have questioned the geometry, radiation distribution, and tumor coverage of T&R compared to T&O. This retrospective study was performed to review clinical cancer control outcomes (local  control, metastasis free survival, and overall survival) at our institution using our HDR T&R brachytherapy boost method.  Local Control 3-year Local Control = 84.2% Methods Metastasis Free Survival • Retrospective review of 139 patients treated from 1997 through 2010 who underwent HDR T&R intracavitary brachytherapy as part of definitive therapy for cervical cancer. • Median total dose to Point A was 87.1 Gy (44-97 Gy). • Median dose per HDR brachytherapy fraction was 6 Gy (range 5-7.5 Gy). • Median follow up was 16 months, (range 0-95 months). • Local control was defined as cervical or vaginal control • Metastasis was defined as metastasis to sites outside the local and pelvic regions 3 –year Metastasis Free Survival = 64.6% Overall Survival Conclusions • Tandem and ring HDR brachytherapy is a feasible alternative to traditional T&O brachytherapy and achieves acceptable outcomes with respect to localcontrol. • Further study regarding acute and late toxicity will be performed. 3-year Overall Survival = 77.8% . Figure 1. The assembled tandem and ring applicator showing the cross braces fixing the tandem to ring at two points and providing rigidity and fixed geometry.