Comparison of intravaginal and interstitial brachytherapy in cervical cancer after inadvertent hysterectomy: a retrospective study.

The purpose of this study was to compare intravaginal brachytherapy (IVBT) with interstitial brachytherapy (ISBT) in patients presenting with residual or recurrent disease after inadvertent hysterectomy for cervical cancer. Records of consecutive patients with cervical cancer, registered in the Radiotherapy Outpatient Department (RTOPD) between March 2018 and March 2021, who had inadvertent hysterectomy followed by external beam radiotherapy (EBRT) and IVBT (n = 15) or ISBT (n = 15) were analyzed retrospectively. All the patients received a dose of 45-50 Gy/25 fractions in 5 weeks by EBRT with concurrent cisplatin. A dose of 6 Gy/fraction/week for two consecutive weeks was prescribed at 5 mm from the surface of the vaginal cylinder in the IVBT arm. Patients in the ISBT arm were treated with 6 Gy/fraction for four fractions over two days with Martinez Universal Perineal Interstitial Template (MUPIT). Overall survival (OS) and disease-free survival (DFS) were the primary endpoints. Acute and late toxicities were the secondary endpoints. Median follow-up (FU) was 24.3 months and 32.8 months in the IVBT and ISBT arms respectively. Most of the patients failed within 12-18 months after brachytherapy. The 3-year OS for IVBT and ISBT arms were 54% and 93% respectively (p = 0.011). The 3-year DFS for IVBT and ISBT arms were 42% and 93% respectively(p = 0.023). Both the arms had similar acute & late toxicities. ISBT had significantly better survival outcomes in terms of OS, and DFS with similar toxicity as compared to IVBT in patients with residual or recurrent disease after inadvertent hysterectomy for cervical cancer.