A comparison of manual and remote afterloading in the treatment of carcinoma of the cervix: Increasing dose rate with a flexible applicator

A historical cohort design was used to assess the effect of introducing a remote afterloading system with a flexible applicator for the intracavitary treatment of cervical cancer. One hundred and sixty-eight patients treated for the 5 years prior to its introduction were compared to 84 patients treated for the first 3 years of its use. Patients were comparable with respect to age and stage. Treatment policies and techniques remained the same during the study period. Average dose rate to point A increased from 0.46 Gy/hr to 0.67 Gy/hr. The 3-year actuarial survival was equivalent between the two treatment modalities: 67.7% (manual), and 60.6% (remote). Patterns of local recurrence and distant failure were also equivalent between the two groups. Severe complication rates were comparable (8.3% manual, 6.3% remote) despite the increase in dose rate, confirming that the remote afterloading system can be safely adapted to a flexible applicator. The introduction of the remote afterloading system resulted in a 72% reduction in radiation exposure to staff.