Recently, in a retrospective analysis, Kang et al (27) showed th

Recently, in a retrospective analysis, Kang et al. (27) showed that the use of CT-based 3D BT resulted in a significant decrease of severe late rectal bleeding and in an improvement of LC for patients with tumor size >4 cm. In a retrospective series including 84 patients with primary locally

advanced cervical carcinoma, Haie-Meder et al. (28) suggest that applying individual treatment planning with 3D MRI-guided LDR BT is feasible and efficient in routine clinical practice and should become the standard modality of gynecologic BT. In 2006, A French prospective multicentric study STIC PDR (Programme de Soutien aux Techniques Innovantes Coûteuses Pulsed Dose Rate) was initiated for patients treated for

cervix carcinoma comparing a PDR BT method based on orthogonal x-rays (two-dimensional group) or based on 3D imaging (3D group). Their results in the 3D arm at 2 years (LC, locoregional control [LRC], and DFS) are relatively similar to ours at 5 years for the two groups of patients with surgery or not (29). For the group with surgery, 2-year LC was 93% vs. 5-year LC was 86.3%, 2-year LRC was 88.6% vs. 5-year LRC was 84%, and 2-year DFS was 77.1% vs. 5-year DFS was 68.3% in our series. For the group without surgery, 2-year LC was 78.5% vs. 5-year LC was 79.4%, 2-year LRC was 69.6% vs. 5-year LRC was 75%, and 2-year DFS was 60.3% vs. 5-year DFS was 60% in Tyrosine Kinase Inhibitor Library our series. Preliminary dosimetric data are published for the first 637 patients: in the 3D arm, concerning the 267 patients treated after EBRT with or without complementary surgery, D100 HR CTV is 10.8 and 16.6 Gy; D90 HR CTV is 17.9 and 26.8 Gy (30), respectively. Our Clomifene retrospective study allows us to compare only the D100 HR CTV [cm3 [EQD2 (10)]. In the group with surgery, our D100 HR CTV was 15.8 Gy cm3 [EQD2 (10)] vs. 10.8 Gy cm3 [EQD2 (10)] (STIC PDR). In the group without surgery, our D100 HR CTV was quite

similar (16.85 Gy) cm3 [EQD2 (10)] vs. 16.6 Gy cm3 [EQD2 (10)] (STIC PDR) (30). In these two series, the D100 HR CTV cm3 [EQD2 (10)] was lower than GEC ESTRO recommendations (14). Dimopoulos et al. (26) obtained an increase in LC rates of 95% if the D90 biologically equivalent dose HR CTV was 87 Gy cm3 [EQD2 (10)] for patients without surgery. Treatment policy in our series was individually tailored according to disease characteristics and response to chemoradiation. Despite the low dose level delivered, the 5-year LC rate was comparable with traditional LDR BT studies (79.4% for patients without surgery) even if recent 3D series relate higher LC with generally more advanced tumors. As example, Pötter et al. (31) related 3-year LC rate of 95% for more advanced with 7.7% Grades 3–4 late complications. Haie-Meder et al. [28] and [31] reported a 2-year LC rate of 89.2% with low Grade 3 delayed toxicity (4.7%). Tan et al.

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