Radiation Therapy Oncology Group Gynecologic Oncology Working Group

Abstract

The purpose of this report is to comprehensively describe the activities of the Gynecologic Oncology Working Group within the RTOG. Clinical trials will be reviewed as well as translational science and ancillary activities. Over the past 40 years, a myriad of clinical trials have been performed within the RTOG with the aim of improving overall survival and decreasing morbidity in women with cervical or endometrial cancer. Major study questions have included hyperbaric oxygen, neutron radiotherapy, altered fractionation, hypoxic cell sensitization, chemosensitization, and volume directed radiotherapy. RTOG 7920 demonstrated improvement in overall survival in patients with stages IB through IIB cervical carcinoma receiving prophylactic paraaortic irradiation compared to pelvic radiation alone. RTOG 9001 demonstrated that cisplatin and 5-FU chemoradiotherapy to the pelvis for advanced cervix cancer markedly improved overall survival compared to extended field radiotherapy alone. More recent trials have employed radioprotectors, molecular targeted therapy, and intensity modulated radiation therapy. Ancillary studies have developed CTV atlases for research protocols and routine clinical use. Worldwide practice patterns have been investigated in cervix, endometrial, and vulvar cancer thru the Gynecologic Cancer Intergroup (GCIG). Translational studies have focused on immunohistochemical markers, changes in gene expression, and miRNA patterns impacting prognosis. The RTOG gynecologic working group has performed clinical trials that have defined the standard of care, improved survival, and added to our understanding of the biology of cervical and endometrial cancers.

The role of para-aortic nodal irradiation in cervical cancer

“…Semi-extended field radiation therapy refers to the inclusion of the macroscopic tumour, uterus, parametrium, upper third of the vagina, pelvic nodes (external and common internal iliac), and excludes the upper third of the para-aortic lymph nodes at the level of the renal vessels, with the corresponding margin. 37 Notably, the site at which the renal vessels emerge ranges from T12 to L2. 38 Recently published guidelines for contouring the paraaortic region describe delineation of the clinical target volume (CTV) for para-aortic lymph nodes.…”

Half‐beam volumetric‐modulated arc therapy in adjuvant radiotherapy for gynecological cancers

“…2,3 Adjuvant radiotherapy is an important modality for treating endometrial and cervical cancers. 4 It is essential not only for patients with advanced diseases but also for those with early-stage cancer to ensure long-term survival. [5][6][7][8][9][10] Nevertheless, adverse events may also occur subsequently.…”