evaluation of survival and treatment toxicity with high-dose-rate brachytherapy with cobalt 60 in carcinoma of cervix

Background: cervical cancer remains to be a major health problem and cancer-related cause of death among women in developing countries such as iran where the most cases are diagnosed in locally advanced stage. objectives: this cross sectional-analytic study aims to report outcome 154 patients with carcinoma of cervix were treated with external beam radiation therapy (ebrt) and high-dose-rate (hdr) brachytherapy with cobalt 60 (co-6o) remote after loading system. patients and methods: a total of 154 patients with the international federation of gynecologist and oncologist (figo) stages i-iva with histopathologically confirmed carcinoma of cervix, followed by the radiation-oncology ward of shohada-e-tajrish hospital in tehran, iran, between february 2008 and march 2015. they were completed their scheduled ebrt and hdr brachytherapy with co-60 remote after loading system. out of this, 132 patients completed their standard follow up protocol. they were analyzed for 3-year disease-free survival (dfs), 3-year overall survival (os) incidence of acute and late complications for hdr brachytherapy. results: fourteen patients (9.1 %) were in stage i (figo classification), 8 (5.2%) were in stage iia, 26 (16.9%) were in stage iib, 100 (64.9%) were in stage iii, and 6 (3.9 %) were in stage iva. the follow up duration was between 6 - 60 months with a median of 38 months. overall rectal and bladder treatment toxicity rates were 33.7%. the 3-year dfs rate was 85.7%, 70.7 %, 41% and 16.6% for stages i, ii, iii, iva respectively. favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm (after adjusting for the residual disease after radiation), no pelvic lymph node involvement and 1 week gap between ebrt and hdr brachytherapy in 3-year dfs (p = 0.001, p = 0.012, p = 0.005, p = 0.005, respectively). the 3-year os rate was 85.7%, 76.4%, 42%, and 33.3% for stages i, ii, iii, and iva, respectively. favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm, no pelvic lymph node involvement, 1 week gap between ebrt and hdr brachytherapy and no distant metastasis (during the follow up) in 3-year os (p = 0.001, p = 0.002, p = 0.002, p = 0.002, p = 0.001, respectively). conclusions: hdr brachytherapy with co-60 remote after loading system was successful and it showed hdr brachytherapy in treating patients with carcinoma of cervix was effective after ebrt with acceptable rectal and bladder complications.