Phase II clinical trial using californium 252 fast neutron brachytherapy, external pelvic radiation, and extrafascial hysterectomy in the treatment of bulky, barrel‐shaped stage IB cervical cancer

John R. Van Nagell, Yosh Maruyama, Elvis S. Donaldson, Michael B. Hanson, Holly H. Gallion, Justine Yoneda, Deborah E. Powell, Richard J. Kryscio, Joseph L. Beach

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Abstract

From June 1977 to June 1983, 32 patients with bulky (>4 cm diameter), barrel‐shaped Stage IB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy using californium 252 (252Cf) and external pelvic radiation followed by extrafascial hysterectomy. Nineteen patients had cervical tumors 4 to 6 cm in diameter, and 13 patients had lesions in excess of 6 cm in diameter. A dose of 4500 rad external photon therapy was given from a linear accelerator, and one or two 6‐hour 252Cf implants were given during or immediately after external radiation. Extrafascial hysterectomy with bilateral salpingo‐oophorectomy was performed 6 weeks after completion of radiation therapy. Complications during and after radiation were minimal and included vaginal stenosis (three) and proctitis (two). Tumor clearance in the hysterectomy specimen was complete in 23 patients (72%) and residual cervical tumor was present in 9 patients (28%). Two patients developed tumor recurrence and died of disease 15 and 27 months after therapy, respectively. Thirty patients remain free of disease 26 to 96 months (median, 52 months) after treatment, and none have been lost to follow‐up. The actuarial survival of these patients is 97% at 2 years and 94% at 5 years. Intracavitary neutron therapy is well tolerated and is effective when combined with external radiation and hysterectomy in the treatment of bulky, barrel‐shaped Stage IB cervical cancer.

Original languageEnglish (US)
Pages (from-to)1918-1922
Number of pages5
JournalCancer
Volume57
Issue number10
DOIs
StatePublished - May 15 1986

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