RESUMO
PURPOSE: This retrospective analysis aims to report results of patients with cervix cancer treated by external beam radiotherapy (EBR) and high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS: From September 1992 to December 1996, 138 patients with FIGO Stages II and III and mean age of 56 years were treated. Median EBR to the whole pelvis was 45 Gy in 25 fractions. Parametrial boost was performed in 93% of patients, with a median dose of 14.4 Gy. Brachytherapy with HDR was performed during EBR or following its completion with a dose of 24 Gy in four weekly fractions of 6 Gy to point A. Median overall treatment time was of 60 days. Patient age, tumor stage, and overall treatment time were variables analyzed for survival and local control. Cumulative biologic effective dose (BED) at rectal and bladder reference points were correlated with late complications in these organs and dose of EBR at parametrium was correlated with small bowel complications. RESULTS: Median follow-up time was 38 months. Overall survival, disease-free survival, and local control at 5 years was 53.7%, 52.7%, and 62%, respectively. By multivariate and univariate analysis, overall treatment time up to 50 days was the only statistically significant adverse variable for overall survival (p = 0.003) and actuarial local control (p = 0.008). The 5-year actuarial incidence of rectal, bladder, and small bowel late complications was 16%, 11%, and 14%, respectively. Patients treated with cumulative BED at rectum points above 110 Gy(3) and at bladder point above 125 Gy(3) had a higher but not statistically significant 5-year actuarial rate of complications at these organs (18% vs. 12%, p = 0.49 and 17% vs. 9%, p = 0.20, respectively). Patients who received parametrial doses larger than 59 Gy had a higher 5-year actuarial rate of complications in the small bowel; however, this was not statistically significant (19% vs. 10%, p = 0.260). CONCLUSION: This series suggests that 45 Gy to the whole pelvis combined with four fractions of 6 Gy to point A with HDR brachytherapy is an effective and safe fractionation schedule in the treatment of Stages II and III cervix cancer if realized up to 50 days. To decrease the small bowel complications, we decreased the superior border of the parametrial fields to the S2-S3 level and the total dose to 54 Gy.
Assuntos
Braquiterapia/métodos , Carcinoma/radioterapia , Teleterapia por Radioisótopo , Dosagem Radioterapêutica , Neoplasias do Colo do Útero/radioterapia , Braquiterapia/efeitos adversos , Carcinoma/mortalidade , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Intestino Delgado/efeitos da radiação , Tábuas de Vida , Pessoa de Meia-Idade , Metástase Neoplásica , Aceleradores de Partículas , Pelve/efeitos da radiação , Lesões por Radiação/epidemiologia , Lesões por Radiação/etiologia , Teleterapia por Radioisótopo/efeitos adversos , Reto/efeitos da radiação , Estudos Retrospectivos , Inquéritos e Questionários , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária/efeitos da radiação , Neoplasias do Colo do Útero/mortalidadeRESUMO
PURPOSE: Brazil has one of the highest incidence of carcinoma of the cervix in the world. Half of the patients have advanced stages at the diagnosis. Due to this large number of patients we decided to conduct a prospective pilot study to investigate the tolerance to and survival rate with hyperfractionated external radiotherapy only in patients with Stage IIIB carcinoma of the uterine cervix. METHODS AND MATERIALS: Between January 1991 and December 1993, 23 patients underwent hyperfractionated external beam radiotherapy without brachytherapy. All cases were biopsy proven squamous cell carcinoma of cervix clinically Staged as IIIB (FIGO). Hyperfractionation (HFX) was given with 1.2 Gy doses, twice daily at 6-h interval, 5 days/week, to the whole pelvis up to 72 Gy within 30 working days. Complications were evaluated by an adaptation ot the RTOG Radiation Morbidity Scoring Table graded as 1 = none/mild; 2 = moderate, and 3 = severe. RESULTS: Follow-up ranged from 27 to 50 months (median 40 months) on the 9 to 23 living patients at the time of the analysis in December 1995. There was no severe acute toxicity, but moderate acute reaction was high: 74%. The commonest site of complication was the intestine where severe late toxicity occurred in 2 of 23 (9%). Overall survival rate at 27 months was 48% and at 40 months was 43%. DISCUSSION: There is little information in literature about HFX in carcinoma of the cervix. This is the third published study about it and the one that gave the highest total dose with external HFX of 60 x 1.2 Gy = 72 Gy. Theoretically, through the linear quadratic formula this schedule of HFX would be equivalent to 30 x 2 Gy = 60 Gy of standard fractionation, both treatments given in 30 working days. HFX schedules must be tested to establish their safety. Present results suggest being possible to further increase the total dose in the pelvis with hyperfractionated irradiation.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias do Colo do Útero/radioterapia , Feminino , Humanos , Estadiamento de Neoplasias , Projetos Piloto , Estudos Prospectivos , Dosagem RadioterapêuticaRESUMO
A irradiaçäo de linfonodos da cadeia mamária interna (CMI) pode ser feita com um campo direto ou com os campos tangentes que irradiam a mama. Quando näo se dispöe de feixe de eletróns, o que é a regra no Brasil, o campo direto costuma irradiar uma área importante de mediastino, pulmäo e coraçäo, se o tumor for do lado esquerdo. A dose usual de 45 a 50 Gy em tais órgäos pode näo ser inócua, causando problemas a médio ou longo prazo, principalmente para as pacientes que väo receber quimioterapia adjuvante com drogas. Além disso, nos casos de tratamento conservador, em que a mama está presente, pode ser difícil a junçäo do campo direto com o campo tangente medial. A tentativa de irradiar a CMI por campos tangentes, entrando contralateralmente 3 cm com o campo tangente medial, pode acarretar perda completa ou dose incerta na CMI, além de irradiar demasiado o pulmäo. Por fim, com a indicaçäo frequente de quimioterapia adjuvante, muitos autores optam por näo irradiar a CMI. Este artigo faz consideraçöes sobre tais assuntos, voltando-se mais aos detalhes técnicos