Treatment of stage IIIB cervical cancer with californium‐252 fast‐neutron brachytherapy and external photon therapy

From January 1977 to July 1984, 32 patients with Stage IIIB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy and external pelvic radiation. These patients received 4500 to 5000 rad external photon therapy and two or three outpatient Californium‐252 (²⁵²Cf) implants, plus sidewall boost irradiation. Treatment results were compared retrospectively to those obtained in a historical control group of patients with Stage IIIB cervical cancer treated with external radiation and conventional photon brachytherapy from 1972 to 1976. Local or regional tumor recurrence developed in 53% of patients treated with neutron therapy and an additional 9% experienced distant metastases. Thirty‐eight percent of patients remain free of disease 12 to 96 months (mean, 51 months) after therapy. The 2‐year and 5‐year survival rates of patients treated with neutron therapy were 53% and 36% which were not significantly different than those obtained with photon brachytherapy (2‐year survival, 61%; 5‐year survival, 34%). Complications of neutron therapy were minimal and included proctitis (19%) and vaginal stenosis (9%). There were no cases of enteric fistulae. Outpatient neutron brachytherapy was cost effective and was well tolerated by patients.