A study of high-dose-rate brachytherapy in the treatment of carcinoma of the uterine cervix

Abstract

AIM: To study the acute side effects associated with HDR brachytherapy and compare it with those of LDR. MATERIALS AND METHODS: Sixty two (62) patients treated with HDR studied. Seven (7) had had previous surgery. Thirty one (31) had HDR intracavitary insertion concomitant with EBT and twenty four (24) after. A total of 104 patients treated with LDR evaluated for comparison. RESULTS: Diarrhoea was the most frequent acute side effect noticed, mostly of low Grade - I & II - recorded in 18/31 (58%) of concomitant arm and 10/ 24 ( 42%) of after-EBT arm. Dysuria was uncommon in HDR patients. Diarrhoea was less frequent in LDR patients - 28/104 (26%) - while dysuria was more frequent - 30/104 ( 29%) - than in HDR patients. These symptoms in LDR patients were mostly of low- grade nature. Previous surgery was associated with a higher incidence of acute side effects - 6/7 (85%) patients had low grade diarrhoea and 2/7 (28%) patients had dysuria. CONCLUSION: Acute side effects associated with two insertions of 7 Gy HDR were low grade and tolerable. Literature review showed that larger numbers of insertions are better tolerated with reduced late complications comparable to those of LDR. Most late complications were associated with fraction sizes greater than 7 or 8 Gy. It is recommended that HDR afterloading treatment continues in Bulawayo using three fractions each of 6 Gy given at weekly intervals, the first two during the course of EBT and the third following completion of EBT, keeping overall time under seven weeks. Further work is indicated to assess the frequency of late complications.