High dose rate cobalt-60 afterloading intracavitary therapy for cervical carcinoma in Srinagarind hospital - analysis of survival.

Abstract

OBJECTIVE: To evaluate the actuarial survival rates in uterine cervical cancer patients treated with teletherapy combined with high dose rate (HDR) cobalt-60 brachytherapy. MATERIALS AND METHODS: A retrospective study of uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations or FIGO), treated by radiotherapy alone between April 1986 and December 1988 was conducted. The patients were treated with teletherapy 50Gy/25 fractions, five fractions per week to the whole pelvis, together with HDR cobalt-60 afterloading brachytherapy of 850 cGy/ fraction, weekly to point A for 2 fractions. RESULTS: The study analysed the records of 141 patients with uterine cervical cancer with a mean age of 50.0 years (range 30-78). The mean tumor size was 4.1 cm in diameter (range 1-8). Mean follow-up time was 2.94 years (range 1 month - 6.92 years). The 5 year actuarial survival rates for patients with small size tumors less than 2 cm in diameter and tumor sizes larger than 2 cm in diameter were 100% and 63.2%. The overall 5 year survival rate was 63.3%. For cancer stages IB, IIB, IIIA and IIIB they were 100%, 80.3%, 100% and 54.8% and for squamous cell carcinoma and adenocarcinoma were 58.3% and 31.2%. CONCLUSION: Combined HDR cobalt-60 brachytherapy and external beam radiotherapy provide a useful modality in the treatment of uterine cervical cancer, feasible for developing countries. The approach demonstrated a slightly elevated radiation morbidity but was most effective in early stages and with small tumor sizes less than 2 cm in diameter.