High‑Dose‑Rate Brachytherapy in the Treatment of Uterine Cervical Cancer Using Cobalt‑60 Radionuclide Source: Three Years Treatment Outcome
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Abstract
Background: The Iridium-192 radionuclide source is commonly used for high-dose-rate brachytherapy of uterine cervical cancer. The cobalt-60 radionuclide source, which is more economical, is now available with dosimetric properties similar to iridium-192.
Objective: To evaluate late gastrointestinal and genitourinary complications, and also the survival pattern in cervical cancer patients treated with cobalt-60 high-dose-rate brachytherapy, three years after treatment.
Materials and Methods: Seventy patients, who were treated with high-dose-rate brachytherapy using the cobalt-60 radionuclide source were followed up for three years. All the patients received 45 Gy of external beam radiotherapy in 22 daily fractions, with 19.5 Gy from high-dose-rate brachytherapy, in three fractions, over three weeks, using the cobalt-60 radio nuclide source. The patients also received concurrent cisplatin-based chemotherapy. Late complications
were assessed every three months, using Radiation Therapy Oncology Group (RTOG) late toxicity criteria. The pattern of disease control was also assessed.
Results: Late complications in the bowel were, six (9%) grade 1, four (6%) grade 2, one (1%) grade 3, and one (1%)
grade 4. The late complications affecting the bladder were 5 (7%) grade 1 and 1 (1%) grade 4. Twenty-eight patients (40%) were alive without disease, seven (10%) were alive with disease, seven (10%) died of persistent disease, four (6%) died of metastatic disease, while 24 (34%) were lost to follow-up.
Conclusion: The late complications were similar to those reported for Iridium-192 as a source of high-dose brachytherapy. Cobalt-60 high-dose-rate brachytherapy is tolerable, effective, and economical for low resource settings.
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