All patients treated at our institution and for
whom medical records were available were selected for inclusion in this retrospective study. Initial locoregional staging included a clinical evaluation performed by a gynecologic surgeon and radiation oncologist (according to the 1995 FIGO (International Federation of Gynecology and Obstetrics) classification (7)). Abdominopelvic MRI was obtained for 168 patients (74.3%) and CT imaging for 160 patients (70.8%). FDG-PET (fluorine-18-fluorodeoxyglucose positron emission tomography) scan was not systematically Selleckchem Sirolimus performed, and no decision has been taken based only on its results; 148 patients (65.4%), mostly Stages I and II, with a good health status and without suspicious lomboaortic nodes at CT or MRI were selected to receive pelvic lymphadenectomy by coelioscopy first. Only 1 patient had a para-aortic lymphadenectomy. Nodal involvement was determined if histologically proven (65 patients) or suspected on CT (24 patients). All patients with positive lymph nodes, including IB1 stage, received first external beam radiation therapy and are included in the study. Stage IB1 patients treated with preoperative intracavitary PDR BT followed with colpohysterectomy were excluded from the analysis (19 patients). Institutional review board approval
was obtained for this study, and it was conducted in compliance with the Helsinki Declaration. All patients received 45 Gy pelvic external beam radiotherapy (EBRT) before PDR BT with a standard four-field technique (190 patients) EGFR inhibitor or a two anterior/posterior opposing fields technique (36 patients) using high E7080 ic50 megavoltage photons from a linear accelerator (photons × 18 and 25 MeV). EBRT included the para-aortic area when the CT showed enlarged common iliac or para-aortic nodes. When the nodal involvement was histologically proved or suspected on CT, a complementary boost irradiation was delivered after BT to reach a minimum of 60 Gy to the parametria and/or involved pelvic nodes and 55 Gy to the para-aortic
nodes, taking into account the dose contribution of BT. From 1999, based on the results of randomized trials , , ,  and , chemotherapy was given during EBRT for all stages ≥IB2, with intravenous cisplatin 40 mg/m² once a week for 5 weeks in 150 of 226 patients (66.4%). Chemotherapy courses were not delivered during the hospitalization for the BT procedure. After EBRT, the PDR BT boost was delivered during a single hospitalization, using the PDR Selectron (Elekta, Stockholm, Sweden). At the beginning of the BT procedure, a careful clinical examination was carried out under general anesthesia to assess clinical response to EBRT. A Fletcher applicator was used, and no patient underwent interstitial BT. Pulses were delivered hourly during night and day. Before 1999, the BT treatment planning dosimetry was based on orthogonal radiographs, in accordance with International Commission on Radiation Units (ICRU) 38 (13).