Whole pelvic helical tomotherapy for locally advanced cervical cancer: technical implementation of IMRT with helical tomothearapy

Abstract

BackgroundTo review the experience and to evaluate the treatment plan of using helical tomotherapy (HT) for the treatment of cervical cancer.MethodsBetween November 1st, 2006 and May 31, 2009, 10 cervical cancer patients histologically confirmed were enrolled. All of the patients received definitive concurrent chemoradiation (CCRT) with whole pelvic HT (WPHT) followed by brachytherapy. During WPHT, all patients were treated with cisplatin, 40 mg/m2 intravenously weekly. Toxicity of treatment was scored according to the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0).ResultsThe mean survival was 25 months (range, 3 to 27 months). The actuarial overall survival, disease-free survival, locoregional control and distant metastasis-free rates at 2 years were 67%, 77%, 90% and 88%, respectively. The average of uniformity index and conformal index was 1.06 and 1.19, respectively. One grade 3 of acute toxicity for diarrhea, thrombocytopenia and three grade 3 leucopenia were noted during CCRT. Only one grade 3 of subacute toxicity for thrombocytopenia was noted. There were no grade 3 or 4 subacute toxicities of anemia, leucopenia, genitourinary or gastrointestinal effects. Compared with conventional whole pelvic radiation therapy (WPRT), WPHT decreases the mean dose to rectum, bladder and intestines successfully.ConclusionHT provides feasible clinical outcomes in locally advanced cervical cancer patients. Long-term follow-up and enroll more locally advanced cervical carcinoma patients by limiting bone marrow radiation dose with WPHT technique is warranted.

Helical tomotherapy provides efficacy similar to that of intensity-modulated radiation therapy with dosimetric benefits for endometrial carcinoma

“…Further, when analyzing helical tomotherapy plans, using IMRT plans as the baseline, helical tomotherapy further decreased the rectal and bladder volumes receiving doses above 30 Gy. Our previous study showed that whole pelvic helical tomotherapy can decrease the mean dose successfully to 10 Gy for the rectum, 10 Gy for the bladder, and 9 Gy for the intestines when compared with whole pelvic radiotherapy for patients with cervical cancer, with 10% and 20% of patients developing grade 3 and grade 2 diarrhea, respectively 3. However, without pelvic bone marrow sparing, even using helical tomotherapy to treat cervical cancer, 30% and 10% of patients still developed grade 3 leukopenia and grade 3 thrombocytopenia, respectively.…”

Stereotactic body radiation therapy via helical tomotherapy to replace brachytherapy for brachytherapy-unsuitable cervical cancer patients – a preliminary result

“…Target objects and normal structures were contoured on a Pinnacle3 treatment planning system (Philips Medical System, Fitchburg, WI, USA). Delineation and constraints were based on Radiation Therapy Oncology Group (RTOG) 0418 protocol, the International Commission on Radiation Units and Measurements (ICRU) Report 50 and Report 62 recommendations, and our hospital guidelines 4. Briefy, the gross tumor volume was defined as all known gross disease determined from CT, clinical information, and MRI.…”

“…Helical tomotherapy (HT), an image-guided IMRT, can deliver highly conformal dose distributions and provides a more impressive critical organ–sparing ability for cervical cancer than does IMRT 4. With the uniqueness of HT, the applications of stereotactic body RT (SBRT), administered via a HT system in place of BT, could be an effective and well-tolerated treatment for cervical cancer 5…”

Helical tomotherapy for cancer treatment: a rapid health technology assessment

“…The 2‐year survival rate for rectal cancer was 93% (progression‐free survival rate, 79%), the 1‐year survival rate for colorectal cancer was 86% (progression‐free survival rate, 25%), and the 1‐year survival rate for colon cancer was 78% (progression‐free survival rate, 14%) (Table ). vii Cervical cancer: the results of 7 observational studies ( n = 176) show that the main adverse reactions associated with HT combination chemotherapy for cervical cancer were gastrointestinal toxicity and blood toxicity; severe gastrointestinal toxicity (≥G3, 2.5–50%); and severe blood toxicity (≥G3, 20–95%). One of these seven studies showed that blood toxicity associated with combination chemotherapy was higher than that associated with HT in the absence of chemotherapy.…”