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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2022.418    [Accepted]
Image-Guided Versus Conventional Brachytherapy for Locally Advanced Cervical Cancer: Experience of Single Institution with the Same Practitioner and Time Period
Tae Hoon Lee1 , Kyung Su Kim1,2, Hak Jae Kim1,2,3,4, Chang Heon Choi1, Seonghee Kang1, Keun-Yong Eom2,5, Chan Woo Wee2,6, Yong Sang Song7, Noh Hyun Park7, Jae-Weon Kim7, Hyun Hoon Chung7, Hee Seung Kim7, Maria Lee7, Hyun-Cheol Kang1,2
1Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
4Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
5Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
6Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
7Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
Correspondence  Hyun-Cheol Kang ,Tel: 82-2-2072-2526, Email: shule@snu.ac.kr
Received: June 30, 2022;  Accepted: August 6, 2022.  Published online: August 10, 2022.
ABSTRACT
Purpose
To compare treatment outcomes and toxicity profile between imaged-guided brachytherapy (IGBT) versus conventional brachytherapy (CBT) performed by the same practitioner during the same time period.
Materials and Methods
Medical records of 104 eligible patients who underwent brachytherapy for locally advanced cervical cancer were retrospectively reviewed. Fifty (48.1%) patients underwent IGBT, and 54 (51.9%) patients underwent CBT. All patients underwent concurrent chemoradiation with cisplatin. High-dose-rate intracavitary brachytherapy with dose prescription of 25-30 Gy in 4-6 fractions was performed for all patients. Late lower gastrointestinal (GI) and urinary toxicities occurred more than three months after the end of brachytherapy were included for comparative and dosimetric analyses.
Results
The median follow-up period was 18.33 months (range, 3.25-38.43 months). There were no differences in oncologic outcomes between the two groups. The IGBT group had lower rate of actuarial grade ≥3 toxicity than the CBT group (2-year 4.5% vs. 25.7%, p=0.030). Cumulative equieffective D2cc of sigmoid colon was significantly correlated with grade ≥2 lower GI toxicity (p=0.033), while equieffective D2cc of rectum (p=0.055) and bladder (p=0.069) showed marginal significance with corresponding grade ≥2 toxicities in the IGBT group. Half of grade ≥3 lower GI toxicities impacted GI tract above the rectum. Optimal thresholds of cumulative D2cc of sigmoid colon and rectum were 69.7 and 70.8 Gy, respectively, for grade ≥2 lower GI toxicity.
Conclusion
IGBT showed superior toxicity profile to CBT. Evaluating the dose to the GI tract above rectum by IGBT might prevent some toxicities.
Key words: Uterine cervical neoplasms, Brachytherapy, Three-dimensional imaging, Rectum, Sigmoid colon 
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