7%) presented with delayed Grade ≥3 complications. Most patients

developed only one Grade ≥3 toxicity (n = 14). Seven patients developed two Grade ≥3 toxicities and 1 patient developed three Grade ≥3 toxicities. Six patients (2.6%) had gastrointestinal tract complications and 10 patients (4.4%) had severe urinary tract toxicity (Grade ≥3). Three patients (1.3%) experienced complete obliteration of the whole vagina (Grade 3). Finally, 123 patients presented Grades 1 and 2 late vaginal side effects Lapatinib in vivo (dryness, atrophy of the vaginal epithelium, partial synechiae, or stenosis of the upper vagina). No statistically significant increase in delayed Grade ≥3 toxicities was observed for any treatment characteristics (EBRT dose <45 vs. ≥45 Gy, two-field vs. four-field technique,

surgery or not, pelvic lymphadenectomy, and concurrent chemotherapy). Dose delivered to 3 cm3 (p = 0.01) or 5 cm3 (p = 0.03) bladder was significantly higher in the group of patients presenting Grade ≥3 urinary complications. Selumetinib With 226 patients and a median followup of over 6.8 years, the present study represents one of the largest series published in PDR BT. With 5-year LC of 85.3% for Stages I and II, 71.4% for Stages III and IV, and 9.7% for Grade ≥3 late toxicity, our results compare favorably with the published reports. Swift et al. (16) reported clinical results of 65 patients with pelvic malignancies (42 patients with primary cervical carcinoma) treated with PDR BT with dose per pulse of 40–80 cGy/h. With a median followup of 15.1 months, the incidence of Grade ≥3 acute complications was 6.5%, which was not higher than that with standard continuous LDR. They attributed their low rate of complications to the isodose optimization capabilities of PDR BT. Rogers et al. (17) reported outcomes for a retrospective cohort of 46 patients with cervical carcinoma treated with PDR BT. With a median followup of 25 months, the overall 4-year DFS rate was 66% for the entire group, 100% for Stage IB, 69% for Stage II, and 68% for Stages III and IV. The 4-year actuarial complication-free survival rate for Grade ≥3 complications was 93%.

More recently, Rath et al. (18) reported the results of a retrospective study of 48 patients treated with PDR intracavitary BT for cervical carcinoma. With a median followup of only 15 months, crotamiton cumulative recurrence-free survival for all patients, Stages I and II, and Stages III and IV was 80%, 82%, and 78%, respectively. The PDR afterloading system has advantages; when compared with previous LDR afterloading systems such as source preparation and inventory are not needed, there is only one source to replace every 3 months, and dosimetry optimization and both intracavitary and interstitial brachytherapies are feasible. Indeed, for a given source strength, the dose rate may be adjusted by modifying dwell times and/or pulse intervals to optimize dose distribution. HDR BT has the same advantages, using a single-stepping source.