A retrospective study of locally advanced cervical cancer cases treated with CT-based 3D-IGBT compared with 2D-IGBT

Abstract

Purpose To retrospectively review locally advanced cervical cancer (CC) cases treated with three-dimensional image-guided brachytherapy (3D-IGBT) and two-dimensional (2D)-IGBT. Materials and Methods Patients with Stage IB–IVa CC who underwent intracavitary irradiation between 2007 and 2021 were divided into the 3D-IGBT and 2D-IGBT groups. Local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), overall survival (OS), and gastrointestinal toxicity (G3 or more) were investigated at 2/3 years post-treatment. Results Seventy-one patients in the 2D-IGBT group from 2007 to 2016 and 61 patients in the 3D-IGBT group from 2016–2021 were included in the study. The median follow-up period was 72.7 (4.6–183.9) months in the 2D-IGBT group and 30.0 (4.2–70.5) months in the 3D-IGBT group. The median age was 65.0 (40–93) years in the 2D-IGBT group and 60.0 (28–87) years in the 3D-IGBT group, but there was no difference in FIGO stage, histology, or tumor size between the groups. In treatment, the median A point dose was 56.1 (40.0–74.0) Gy in the 2D-IGBT group and 64.0 (52.0–76.8) Gy in the 3D-IGBT group (P < 0.0001), and the proportion of patients who underwent chemotherapy more than five times was 54.3% in the 2D-IGBT group and 80.8% in the 3D-IGBT group (P = 0.0004). The 2/3-year LC, DMFS, PFS, and OS rates were 87.3%/85.5%, 77.4%/65.0%, 69.9%/59.9%, and 87.9%/77.9% in the 2D-IGBT group, and 94.2%/94.2%, 81.8%/81.8%, 80.5%/80.5%, and 91.6%/83.0% in the 3D-IGBT group, respectively. A significant difference was observed in PFS (P = 0.02). There was no difference in gastrointestinal toxicity, but there were four intestinal perforations in the patients from the 3D-IGBT group, three of whom had a history of bevacizumab treatment. Conclusion The 2/3-year LC of the 3D-IGBT group was excellent and PFS also tended to improve. Care should be taken with concomitant use of bevacizumab after radiotherapy.

Revolutionizing radiation therapy: the role of AI in clinical practice

“…Radiotherapy has a history of improvement along with the advances in diagnostic imaging. With the advent of computed tomography (CT), the ability to depict tumors not as shadows but as 3D structures has advanced radiotherapy from 2D to 3D [ 1 ]. Furthermore, the diagnosis of tumor spread and boundaries was made by contrasting preoperative images with surgical pathology [ 2–5 ].…”