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Combined External and Intracavitary Irradiation in Treatment of Advanced Cervical Carcinomas: Predictive Factors for Treatment Outcome and Early and Late Radiation Reactions

Bohr Mordhorst, Louise MD*; Karlsson, Leif BSc; Bärmark, Berit RN*; Sorbe, Bengt MD, PhD*

International Journal of Gynecological Cancer: September 2014 - Volume 24 - Issue 7 - p 1268–1275
doi: 10.1097/IGC.0000000000000208
Cervical Cancer

Objective The objective of this study was to find out predictive factors of tumor control as well as acute and late radiation reactions in treatment of advanced cervical carcinomas.

Methods In a series of 134 primary cervical carcinomas in International Federation of Gynecology and Obstetrics stages I to IV treated with combined external pelvic and intraluminal cervical-vaginal brachytherapy, predictive and prognostic factors were analyzed with regard to tumor control, recurrences, survival data, and adverse effects. Concomitant chemotherapy was given to 48 patients (35.8%). The external beam therapy was given with a 4-field technique (50–60 Gy) and brachytherapy was given with a high-dose rate (iridium-192) afterloading technique using a ring applicator set. A computed tomographically based 3-dimensional dose-planning system was used for the external beam therapy and for the brachytherapy planning. The mean age of the patients was 65 years. A total of 110 tumors were squamous cell carcinomas and 24 were adenocarcinomas or adenosquamous carcinomas. A total of 111 tumors were in International Federation of Gynecology and Obstetrics stages I to II; 23 tumors, in stages III to IV.

Results The primary control rate of the complete series was 92.5%. Tumor size, the brachytherapy dose, the combined external and brachytherapy dose, as well as the number of days of interruption (delay) of irradiation were all significant predictive factors for local tumor control. Forty recurrences (30%) were recorded. Early radiation reactions were recorded in 67% (mostly grade 1) and were associated with the widths of the anterior-posterior and lateral pelvic fields. Serious late radiations reactions (grade 3–4) were noted in 11%.

Conclusions The width of the lateral pelvic fields, left point A and B doses, dose to the rectal reference point, as well as asymmetry of the dose distribution were associated with late severe reactions. Prior abdominal and pelvic surgery was also a high-risk factor for late tissue reactions. Concomitant chemotherapy did not increase the risk for acute or late toxicity.

Departments of *Oncology, and †Radiation Physics, Örebro University Hospital, Örebro, Sweden.

Address correspondence reprint requests to Bengt Sorbe, MD, PhD, Department of Gynecological Oncology, Örebro University Hospital, S-701 85 Örebro, Sweden. E-mail:

The authors declare no conflict of interest.

Received December 28, 2013

Received in revised form May 26, 2014

Accepted June 9, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.