High precision radiotherapy including intensity-modulated radiation therapy and pulsed-dose-rate brachytherapy for cervical cancer: a retrospective monoinstitutional study

Abstract

To analyse the survival outcomes and toxicity profile of patients treated with pulsed-dose-rate (PDR) brachytherapy (BT) after intensity-modulated radiation therapy (IMRT) for uterine cervical cancer in a single institution. Material and methods: Between March 2011 and December 2014, 50 patients with histologically proven stages IB1-IVB cervical cancer were treated with IMRT followed by PDR-BT boost. Radiation treatment consisted of IMRT to pelvic with or without paraaortic lymph nodes to a total dose of 45-50.4 Gy. Weekly concomitant chemotherapy was administered to 45 patients. PDR-BT boost was delivered with a median dose of 30 Gy to the high-risk clinical target volume (HR-CTV) after a median time of 14 days since IMRT. Acute and late toxicity were evaluated by Radiation Therapy Oncology Group (RTOG)-European Organization for Research and Treatment of Cancer (EORTC) scoring criteria and Subjective Objective Management Analytic-Late Effects of Normal Tissues (SOMA-LENT) criteria. Results: Two patients had tumour persistence at 6 months after the end of BT. After a median follow-up of 33 months, 6 distant metastases with or without regional relapse were observed. The 1-and 5-year progression-free survival was 83% (95% CI: 69-91%) and 76% (95% CI: 61-86%), whereas the 3-and 5-year overall survival was 91% (95% CI: 78-97%) and 76% (95% CI: 56-88%), respectively. Urinary and rectal toxicity higher than grade 2 was observed in 6.3% and 17% of patients, respectively. Five patients (10.6%) had grade 4 gastrointestinal toxicity requiring colostomy. Conclusions: Our study confirms that the combination of IMRT and PDR-BT can be considered an effective treatment for cervical cancer, ensuring high local control, despite the high percentage of locally advanced disease.

Local treatment strategies in Stage IVB cervical squamous cell carcinoma and adenocarcinoma

“…Compared with surgical treatment, radiotherapy is non-invasive and patients have fewer adverse effects in the intensity-modulated radiation therapy era. [22][23][24][25][26] This may be the reason why the proportion of radiotherapy has increased in recent years in this population.…”

“…For Stage IVB cervical cancer, the main purpose of systemic therapy and local therapy is to prolong survival and improve the quality of life of patients. Compared with surgical treatment, radiotherapy is non‐invasive and patients have fewer adverse effects in the intensity‐modulated radiation therapy era 22–26 . This may be the reason why the proportion of radiotherapy has increased in recent years in this population.…”

Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy

“…Endo/interstitial BT is recommended as a definitive treatment for cervical cancer, as it can deliver high-dose radiation to the tumor while limiting the irradiation of adjacent organs. A population-based analysis revealed that BT use is independently associated with a significantly higher OS, whilst patients unfit for BT are at higher risk of local recurrence (1,3,9,34).…”