Lertsanguansinchai P et al. (2004) Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma. Int J Radiat Oncol Biol Phys 59: 1424–1431

Brachytherapy is widely used, in combination with external beam radiotherapy (EBRT), in the treatment of cervical cancer. It is unclear, however, whether high-dose-rate (HDR) brachytherapy is superior to the more traditional low-dose-rate (LDR) approach in terms of tumor control and complication rate. Lertsanguansinchai and colleagues have recently reported on a prospective, randomized trial comparing the two approaches.

Women with previously untreated, invasive cervical cancer were randomized into two brachytherapy groups, LDR and HDR. All patients were also treated with EBRT in an integrated procedure. Survival, tumor control and complication rates were compared between the two brachytherapy groups.

Median follow-up was for 40.2 months in the LDR group (n = 109) and 37.2 months in the HDR group (n = 112). The overall survival, relapse-free survival and pelvic control rates were similar in the two groups. Complications (affecting the rectum, bladder and small bowel) also occurred at similar rates. There was a relatively high rate of distant metastases in both groups and the authors suggest that alternative treatment modalities should be considered, particularly for Stage IIB and IIIB patients.

In conclusion, HDR brachytherapy was clinically comparable to LDR brachytherapy in this study. Although the optimum dose-fractionation schedule remains to be determined, HDR brachytherapy may offer benefits including improved patient convenience and reduced exposure of staff to radiation.