University of Miami experience using one versus two intracavitary brachytherapy implants

This retrospective study was done to determine whether the number of brachytherapy implants significantly influenced outcome in 86 patients with carcinoma of the cervix treated with radiation alone at the University of Miami/Jackson Memorial Hospital from August 1981 to May 1995. One brachytherapy application was performed in 36 (42%) of the study cohort, whereas 50 (58%) had two implants. Cumulative doses to points A and B ranged from 60.74 Gy to 97.58 Gy (median: 82.46 Gy) and 46.57 Gy to 73.99 Gy (median: 58.51 Gy), respectively. Five-year overall survival (OS) and disease-free survival (DFS) for study patients were 49.4% and 38.7%, respectively. Patients receiving two implants had a higher total dose to point A (p = 0.02), were less likely to complete the radiation in less than 8 weeks (p = 0.01), and showed a trend of having more advanced disease (p = 0.1) and a greater rate of chronic complications (p = 0.09). Univariate analysis failed to demonstrate a statistically significant difference in either OS or DFS concerning one versus two brachytherapy procedures in this series. However, because of the confounding interactions of cumulative dose to point A and overall treatment time in the present series, a prospectively randomized phase III trial is needed to more adequately evaluate this question.