Intensity-modulated radiation therapy versus three-dimensional conformal radiation therapy with concurrent nedaplatin-based chemotherapy after radical hysterectomy for uterine cervical cancer: comparison of outcomes, complications, and dose-volume histogram parameters

Abstract

BackgroundThe purpose of this study is to report our clinical outcomes using intensity-modulated radiation therapy (IMRT) for adjuvant treatment of cervical cancer, compared with three-dimensional conformal radiation therapy (3DCRT), in terms of tumor control, complications and dose-volume histogram (DVH) parameters.MethodsBetween March 2008 and February 2014, 62 patients were treated with concurrent nedaplatin-based chemotherapy and whole-pelvic external beam radiation therapy (RT). Of these patients, 32 (52 %) received 3DCRT and 30 (48 %) received IMRT.ResultsThe median follow-up periods were 40 months (range 2–74 months). The 3-year overall survival rate (OS), locoregional control rate (LRC) and progression-free survival rate (PFS) were 92, 95 and 92 % in the IMRT group, and 85, 82 and 70 % in the 3DCRT group, respectively. A comparison of OS, LRC and PFS showed no significant differences between IMRT and 3DCRT. The 3-year cumulative incidences of grade 2 or higher chronic gastrointestinal (GI) complications were significantly lower with IMRT compared to 3DCRT (3 % vs. 45 %, p < .02) and in patients with V40 of the small bowel loops of ≤340 mL compared to those with >340 mL (3 % vs. 45 %, p < .001). Patients treated with IMRT had a higher incidence of grade 3 acute hematologic complications (p < .05). V40 and V45 of the small bowel loops or bowel bag were predictive for development of both acute and chronic GI complications.ConclusionsOur results suggest that IMRT for adjuvant treatment of cervical cancer is useful for decreasing GI complications without worsening outcomes.

Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: a multicenter retrospective study (KROG 13-08)

“…Regarding complications, substantial grade 2 to 3 toxicities have been observed in re-irradiated patients [25]. Comparative studies of the dose parameters, outcomes, and complications of postoperative IMRT and conventional or three-dimensional conformal RT for gynecologic cancers demonstrated significant reductions in toxicities without compromising clinical outcomes [26272829]. Therefore, IMRT should be considered for these patients in order to reduce toxicity while improving locoregional control.…”

Dose–volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy

“…It should be noted that patients with a volume above the threshold volume did not show a greater frequency of chronic GI complications unless another volume exceeded the threshold. Previous clinical reports have suggested that IMRT is useful for decreasing chronic GI complications by reducing the relatively high-dose volume to the bowels [2, 12]. Also, due to the properties of IMRT, it is difficult to reduce the volume of a relatively low dose.…”

“…The organs at risk that were contoured comprised the small bowel loops, large bowel loop and bowel bag. Details of RT and contouring of bowels have been described elsewhere [1, 2]. Nedaplatin (40 mg/m 2 ) was given intravenously on a weekly basis for 5–6 weeks during the course of WPRT.…”

“…Based on these results, since October 2010 we have used intensity-modulated radiation therapy (IMRT) as postoperative WPRT for uterine cervical cancer [2]. Since publication of our DVH findings, several other reports have shown a correlation between DVH parameters and chronic GI complications in patients with postoperative cervical cancer [3, 4].…”

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

“…Bowel: For rectal cancer patients, preoperatively treated with 3D-CRT, the absolute bowel volume receiving !15 Gy (V 15Gy ) has consistently been found to correlate with acute GI toxicity [7][8][9][10][11]. Studies of rectal [12], anal [13][14][15][16][17], prostate [18][19][20] and gynaecological [21][22][23] cancer patients treated with IMRT or arc therapy have found correlations between acute GI toxicity and dose levels from approximately 25-45 Gy, delivered in 25-28 fractions. For late GI toxicity in rectal cancer, the data is very limited.…”