HDR interstitial perineal implant for locally advanced or recurrent uterine cervix cancer.

PURPOSE: To evaluate whether high-dose-rate (HDR) interstitial perineal implants can effectively eradicate residual tumor or recurrent tumor in uterine cervix cancer after complete radiation treatment. MATERIALS AND METHODS: This method of treatment was commenced in January 2002, and four advanced stage and four uterine cervix cancer (UCC) recurrences were admitted for this study. All untreated stage II bulky mass and IIIB patients received 50 Gy external beam radiotherapy (EBR) to the whole pelvis prior to the interstitial perineal implant. No EBR was given to recurrent UCC. Brachytherapy was delivered using Martinez Universal Perineal Interstitial Template (MUPIT) and 192Ir HDR. This implant will only be done if residual disease on the parametria was bimanually palpable or was proven by CT scan or MRI. The dose of interstitial brachytherapy boost to the parametria was 17 to 30 Gy, and treatment days ranged from 42 to 64 days. Uterine recurrences were found on the uterine cervix and/or parametria. The dose delivered by this implant ranged from 6 to 16 Gy and encompassed either uterus or vaginal stump and both parametria. Total treatment days ranged from 1 to 2 days. RESULTS: This short-term study showed that almost all tumors were locally controlled when the study was closed (1 to 15 months). One distant metastasis was found. No significant morbidity has been identified until now. CONCLUSION: HDR 192Ir interstitial perineal implants were proven to be effective in eradicating tumor cells in advanced stage UCC and recurrent disease with no significant morbidity.