Outcomes And Prognostic Factors Of Brachytherapy For 31patients With Recurrent Cervical Cancer After Radiotherapy

Objective:To analyze the efficacy,toxicity and prognostic factors of brachytherapy used as reirradiation method in patients with recurrent cervical cancer.Methods:We retrospectively analyzed the 31 patients with recurrent cervical cancer reirradiated with brachytherapy from March 2015 to June 2018 at the Department of Radiation Oncology,China-Japan Union Hospital of Jilin University.For reirradiation,14 patients underwent combined intracavitary and interstitial brachytherapy,17 patients underwent interstitial brachytherapy.Five patients combined external radiotherapy due to insufficient dose of previously radiotherapy or abdominal aortic lymph node metastasis.The tumor response was assessed according to the Response Evaluation Criteria in Solid Tumors(RECIST),and late toxicity was graded according to the Radiation Therapy Oncology Group(RTOG)late radiation morbidity scoring scheme.Overall survival(OS),progression-free survival(PFS)and local control(LC)were calculated by Kaplan-Meier survival analysis.Log rank test was performed to analyze the recurrence tumor diameter(≥4cm VS.< 4cm),initial clinical stages(stageⅠ and Ⅱ VS.Ⅲ and Ⅳ),reirradiation dose(≥40Gy VS.< 40Gy),the disease-free interval(≥12 months VS.< 12 months),interval between primary radiotherapy and reirradiation(≥12 months VS.< 12 months).Cox regression model was used for multivariate analysis.P < 0.05 was considered statistically significant.Results:The median reirradiation EQD2 was 39.70Gy(12.50~80.90Gy)and the median cumulative EQD2 calculated for primary radiotherapy and reirradiation was 105.25Gy(79.67-164.25Gy).Complete remission(CR)was achieved in 18 patients,partial remission(PR)was achieved in 12 patients and 1 patient achieved stable disease(SD).The total response rate was 96.8%.The median follow-up time was 23.9 months(8~46.9 months).12 patients are free of disease post treatment,local recurrence alone was observed in 4 patients,distant metastasis was observed in 5 patients,local recurrence and distant metastasis in 7 patients.The 1-year OS,PFS and LC rate were77.4%,67.7% and 74.2%,2-year OS,PFS and LC rate were 61.3%,54.8% and 64.5%,3-year OS,PFS and LC rate were 58.1%,54.8% and 64.5%,respectively.During the treatment,2 patients had grade Ⅲ Leukopenia and without any grade Ⅲ-Ⅳacute bladder and rectal toxicity.Grade Ⅲ bladder late toxicity was observed in 3 patients(bladder D2 cc cumulative EQD2 was 96.92 Gy,138.66 Gy and 75.94 Gy,respectively);1 patient had severe vaginal stenosis;1 patient had rectovaginal fistula(cumulative EQD2 was 149.22 Gy,cumulative rectal D2 CC EQD2 was 90.10Gy).Univariate analysis showed that recurrence tumor diameter,the disease-free interval and interval between primary radiotherapy and reirradiation had statistical difference for OS,PFS and LC in 1,2,3 years,and no statistical difference was found for OS,PFS and LC in the initial clinical stage and the reirradiation dose in 1,2,3 years.COX model showed that the recurrence tumor diameter and interval between primary radiotherapy and reirradiation were independent prognostic factors for OS,PFS and LC.Conclusion:Reirradiation using brachytherapy for recurrent cervical cancer is an effective method,with low incidence of severe toxicity,and can preserve pelvic organs and improve the quality of life.The recurrence tumor diameter and interval between primary radiotherapy and reirradiation are independent prognostic factors for postrecurrence survival.In clinical practice,we should selected patients who would benefit from this treatment.