Combination of Intracavitary and Interstitial Brachytherapy in Complete Chemoirradiation of Locally Advanced Cervical Cancer – Case Report

Introduction: Complete chemoirradiation is the main treatment choice for locally advanced cervical carcinoma. Brachytherapy has an important role in dose escalation to the primary tumor. In addition to intracavitary, interstitial brachytherapy enables grater coverage of gross tumor volume in locally advanced cervical carcinoma. Material and Methods: The patient in the initial FIGO IIB stage was indicated for complete chemoirradiation. EBRT with a dose of 45Gy/25fr was performed with concomitant chemopotentiation with Cisplatin (40mg/m2) in a weekly regimen. After that, a combination of intracavitary and interstitial brachytherapy was performed. A Fletcher applicator was used along with 8 interstitial needles with a diameter of 2.0 mm and a length of 320 mm. Two implantations were carried out one week apart with two fractions at interval of 6 hours, with a dose of 7Gy on the HR-CTV. In total, 4 fractions with 7 Gy per fraction. Planning was done on MRI. Results: A voluminous lesion of the cervix was described on the initial diagnostic MRI examination with a longer diameter of 5 cm in the left hemiaspect, with involvement of the anterior and posterior lips of the cervix and infiltration of the stroma in the entire thickness and parametria on the left side. Five months after the last brachytherapy application, a control MRI of the pelvis was performed, and the complete regression of cervical carcinoma was described- complete radiological response. In correlation with clinical examination there was also complete clinical response. Conclusion: Combination of intracavitary and interstitial MRI-based brachytherapy in patients with locally advanced disease after external-beam therapy has proved to be good in long-term disease control.