Perioperative morbidity and mortality of gynecologic brachytherapy

Article Abstract:

For many forms of cancer, the term radiotherapy actually implies external beam irradiation, in which the radiation is directed at the tumor from an external source. For some cancers, however, brachytherapy is commonly used. In this method, a small radioactive pellet is implanted directly into the area of the cancer. The purpose is to obtain a high level of radiation which is relatively limited to the involved area and which minimizes the exposure of surrounding tissues. Brachytherapy is commonly used on gynecologic cancers, including cervical cancer, endometrial cancer, and cancer of the vagina. Because these cancers often affect elderly patients, it is important to consider not only the effectiveness of the treatment method but also the effects which the treatment itself has on the health and well-being of the patient. In this study, the effects of 462 instances of brachytherapy treatment on 327 patients with gynecologic cancer were reviewed. A total of 21 patients, or 6.4 percent, experienced some sort of potentially life-threatening complication. In 16 patients, these complications took the form of a heart attack, congestive heart failure, abnormal heartbeat patterns, or other complications involving the heart. Four patients developed thromboembolic complications, in which a blood clot formed and then blocked a blood vessel; in one such case, the blood vessel was in the lungs and the embolus resulted in death. In addition to this patient, four other patients died. Three patients died of heart attacks and one of heart failure resulting from pneumonia. Data analysis revealed that the patients who suffered life-threatening complications tended to be older on the average and were also likely to have had preexisting heart problems. The identification of patients who are at an especially high risk for complications of brachytherapy might be possible in advance, so that postoperative complications could be reduced by appropriate intensive care for the patients who need it most. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Cancer, Radioisotope brachytherapy, Brachytherapy

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The interplay of local and distant control in the cure of cervical cancer

Article Abstract:

Cancer of the uterine cervix has substantial treatment failure rates. These failures may take the form of local recurrence in the pelvic area or as distant metastases elsewhere in the body. While improvements in the treatment of disseminated cervical cancer would almost certainly come from new chemotherapeutic techniques, improvements in local control might be surgical, chemotherapeutic, or radiotherapeutic. In an effort to determine which direction of investigation holds the greatest promise for improvements in survival, researchers carefully analyzed the pattern of failure among 183 women with cervical cancer who received radiotherapy and surgery, which included surgical staging of pelvic lymph nodes. During a median follow-up period of over six years, 4 percent of the patients experienced local relapse only, 13 percent developed distant disease only, and 17 percent failed due to the development of both local and distant disease. Mathematical analysis demonstrated that improvements in local control are likely to have less effect on the overall mortality due to cervical cancer than are improvements in chemotherapy, which will lead to better control of distant metastases. In addition, systemic chemotherapy will, of course, also affect local tumor growth as well. The authors point out, however, that the reported recurrence rates of cervical cancer generally come from major medical centers and university hospitals, which usually achieve results superior to those of general practices. Therefore, while gains in chemotherapy are most likely to improve the best results that can be achieved, better average results may be achieved by developing uniform techniques of radiotherapy. Uniformity of radiotherapy may permit the general practice of radiotherapy around the country to achieve results comparable to those obtained in large medical centers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Chemotherapy

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The patterns of care outcome study for cancer of the uterine cervix: results of the Second National Practice Survey

Article Abstract:

The Patterns of Care Study, or PCS, compiles statistics on the use of radiotherapy for the treatment of cancer. These statistics provide a basis for comparing treatments involving radiotherapy. One of the forms of cancer for which radiotherapy is an important mode of treatment is cervical cancer. The treatment of uterine cervical cancer was first reviewed by PCS in 1973; more recent data is now reported from patients treated in 1978 with outcomes recorded from 1982 through 1984. Five factors related to the tumor and three related to the treatment were significantly correlated with survival when considered alone. It is not surprising that survival was related to tumor stage; five-year survival with no evidence of disease was 74 percent for Stage I cancer, 56 percent for Stage II, and 33 percent for Stage III. Improved survival for smaller tumors was significant only when tumor stage was not considered in the analysis. Patients in whom parametrial involvement was only on one side had a survival advantage at four years over those in whom the involvement was bilateral (58 vs 47 percent, respectively). The study also found that the implantation of radioisotopes provided superior treatment than the use of external beam irradiation. Furthermore, patients with two or more insertions of radioisotopes had a survival advantage over those who had only one. The recommended radiation dose of 65 Gy was found to be important; the four-year survival of those who received less radiation was 42 percent (in contrast to 68 percent among those who received a greater dose). The study also revealed that bowel obstruction was the major complication associated with treatment. The authors recommend that surgical treatment of cervical cancer not involve the peritoneal cavity, as this seems to increase the likelihood of complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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