High Dose Rate Cobalt-60 Afterloading Intracavitary Therapyof Uterine Cervical Carcinomas in Srinagarind Hospital -Analysis of Complications

Objectives: To evaluate complications in uterine cervical cancer patients treated with teletherapy combinedwith high dose rate(HDR) cobalt-60 brachytherapy. Materials and
Methods: A retrospective study of uterinecervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetriciansrecommendations), treated by radiotherapy alone between April 1986 and December 1988 was conducted. Thepatients received teletherapy 50Gy / 25 fractions, five fractions per week to the whole pelvis together with HDRCobalt -60 afterloading brachytherapy of 850 cGy/ fraction weekly to point A for 2 fractions.
Results: Thestudy subjects were 141 patients with uterine cervical cancer. The mean age was 49 years with a range of 30-78. The mean tumor size was 4.1 cms in diameter (range 1-8 cms ). Mean follow-up time was 2.9 years (range1 month - 6.9years). The treatments resulted in a 96.5% complete response rates but morbidity rates of grade1 and grade 2 radiation proctitis of 27.0%, and 10.6 %.The grade 1 and grade 2 radiation cystitis were 1.4%,and 1.4 %. At the level of grade 3 radiation complications, 0.71% of radiation proctitis and 0.71% small bowelobstruction were observed. The mean onset time to develop radiation proctitis after complete treatment was 15months with a range of 6-61 months, for radiation cystitis was 30 months (range 9 - 47 months) and for smallbowel obstruction was 53 months in the one case it occurred.
Conclusion: Combined teletherapy along with highdose rate Cobalt -60 brachytherapy of 850 cGy/ fraction, weekly to point A for 2 fractions for uterine cancerdemonstrated a slightly higher incidence of grade 2 radiation proctitis. Therefore, treatment using HDR-60brachytherapy less than 850 cGy per fractionation for decreasing the grade 2 and grade 3 radiation morbidityis recommended.