Comparision of Intravaginal with Interstitial Brachytherapy in Cervical Cancer after Inadvertent Hysterectomy: A Retrospective Study

Abstract

Purpose The purpose of this study was to compare intravaginal (IVBT) with interstitial brachytherapy (ISBT) in patients presenting with residual or recurrent disease after inadvertent hysterectomy for cervical cancer. Methods Records of consecutive patients with cervical cancer, registered in the Radiotherapy Outpatient Department (RTOPD) between March 2018 and March 2021, who had inadvertent hysterectomy followed by external beam radiotherapy (EBRT) and IVBT (n = 15) or ISBT (n = 15) were analyzed retrospectively. All the patients received a dose of 45Gy-50Gy/25 fractions in 5 weeks by EBRT with concurrent cisplatin. A dose of 6Gy/fraction/week for two consecutive weeks was prescribed at 5mm from the surface of the vaginal cylinder in the IVBT arm. Patients in the ISBT arm were treated with 6Gy/fraction for four fractions over two days with Martinez Interstitial Perineal Template (MUPIT). Overall survival (OS) and disease-free survival (DFS) were the primary endpoints. Acute and late toxicities were the secondary endpoints. Results Median follow-up (FU) was 24.3 months and 32.8 months in the IVBT and ISBT arms respectively. The 3-year OS and DFS for IVBT and ISBT arms were 54% and 93% (p = 0.011) and 42% and 93% (p = 0.023), respectively. Both the arms had similar acute & late toxicities. Conclusion ISBT had significantly better survival outcomes in terms of OS, and DFS with similar toxicity as compared to IVBT in patients with residual or recurrent disease after inadvertent hysterectomy for cervical cancer.