Comparison of vaginal gauze packing technique with or without balloon in high-dose-rate brachytherapy of uterine cervical cancer: a crossover randomized controlled trial

Purpose
To compare the rectal and bladder doses using two different vaginal packing techniques among uterine cervical cancer patients receiving high-dose-rate (HDR) intracavitary brachytherapy (ICBT).

Material and methods
Forty-five patients with cervical cancer were randomized to receive two sessions of ICBT using tandem and ring applicator (Varian©), following completion of pelvic external beam radiotherapy treatment. The procedure was performed with vaginal balloon plus gauze packing or vaginal gauze packing alone, each of which was used in one of two sessions. Sequence of the type of vaginal packing was chosen with computer-generated block randomization. A HDR dose of 8.5 Gy was prescribed to point A in all patients. Volumetric dose parameters, such as D_0.1cc, D_0.5cc, D_1cc, and D_2cc of the rectum and bladder were compared between the two techniques of vaginal packing.

Results
The mean age of patients was 51 years. Majority (88%) of patients had locally advanced stages of cancer at baseline (stage IIB or more). Rectal doses were significantly less in combined packing technique (D_0.1cc: 7.52 Gy vs. 9.02 Gy, p = 0.01; D_0.5cc: 6.46 Gy vs. 7.42 Gy, p < 0.01; D_1cc: 5.91 Gy vs. 6.7 Gy, p < 0.01; D_2cc: 5.29 Gy vs. 5.97 Gy, p < 0.01). Bladder doses were higher in the combined packing technique (D_0.1cc: 11.20 Gy vs. 10.76 Gy, p = 0.18; D_0.5cc: 9.64 Gy vs. 9.32 Gy, p = 0.56; D_1cc: 8.64 Gy vs. 8.36 Gy, p = 0.55; D_2cc: 7.56 vs. 7.33 Gy, p = 0.55).

Conclusions
Combined vaginal packing resulted in statistically significant reduction in rectal radiation dose compared with standard vaginal gauze packing in high-dose-rate brachytherapy of cervix cancer using tandem and ring applicators.