@Article{Opfermann2012,
journal="Journal of Contemporary Brachytherapy",
issn="1689-832X",
volume="4",
number="1",
year="2012",
title="Clinical InvestigationsImpact of point A asymmetry on local control 
and survival for low dose-rate (LDR) brachytherapy in cervical cancer",
abstract=" Purpose : To evaluate whether Point A asymmetry in low dose-rate (LDR) brachytherapy is associated with local control (LC), disease-free survival (DFS) and/or overall survival (OS).   Material and methods : A retrospective analysis of disease control and survival outcomes was conducted for patients who underwent LDR brachytherapy for advanced cervical cancer. Institutional protocol entailed concurrent chemothe-rapy and whole pelvis radiotherapy (WPRT) over 5 weeks, followed by placement of Fletcher-Suit tandem and colpostat applicators at weeks 6 and 8. Objective Point A doses, 80-85 Gy, were accomplished by placement of Cesium-137 (Cs-137) sources. Cox proportional hazards regression models were used to assess associations between disease control and survival endpoints with variables of interest.   Results : The records of 50 patients with FIGO stage IB1-IVA cervical cancer undergoing LDR brachytherapy at our institution were identified. Thirty of these patients had asymmetry > 2.5%, and 11 patients had asymmetry > 5%. At a median survivor follow-up of 20.25 months, 15 patients had experienced disease failure (including 5 cervical/vaginal apex only failures and 2 failures encompassing the local site). Right/left dose asymmetry at Point A was associated with statistically significantly inferior LC (p = 0.035) and inferior DFS (p = 0.011) for patients with mean Point A dose of > 80 Gy. Insufficient evidence existed to conclude an association with OS.    Conclusions : LDR brachytherapy may be associated with clinically significant dose asymmetry. The present study demonstrates that patients with Point A asymmetry have a higher risk of failure for DFS and LC.",
author="Opfermann, Krisha J
and Wahlquist, Amy
and Watkins, John
and Kohler, Matthew
and Jenrette III, Joseph",
pages="3--7",
doi="10.5114/jcb.2012.27945",
url="http://dx.doi.org/10.5114/jcb.2012.27945"
}