Clinical results of external beam radiotherapy alone with a concomitant boost program or with conventional fractionation for cervical cancer patients who did not receive intracavitary brachytherapy

Abstract

A combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) is well established as the standard radical radiotherapy (RT) for cervical cancer. However, it is sometimes necessary to perform EBRT alone for patients where ICBT is not feasible. For these patients, we initiated EBRT alone with three-dimensional conformal radiotherapy (3DCRT). The purpose of this study is to evaluate the results of EBRT alone without ICBT for patients with cervical cancer. Sixteen patients were treated with EBRT alone between 2002 and 2009. There were three stage IIB, six stage IIIB and seven patients with stage IVA disease. A total of 10 patients were treated with a median dose of 66 Gy with a median overall treatment time (OTT) of 40 days delivered by a concomitant boost (CCB), and a median dose of 60 Gy with a median OTT of 47 days was administered for six patients by conventional fractionation (CF). The 3-year overall survival (OAS) and local control (LC) rates were 43.8% and 75.0%, respectively. The 3-year LC rate was 90.0% for the CCB group, 50.0% for the CF group (P = 0.0692); 100% for OTT ≤42 days, 42.9% for OTT ≥43 days (P = 0.0095). No severe acute and late adverse effects were encountered for any of the patients. These outcomes suggest that EBRT with a CCB program may be a promising radical treatment for cervical cancer that provides better LC with minimal complications, especially in cases where ICBT cannot be performed.

Radioterapia Externa Exclusiva en Carcinoma Invasor Avanzado del Cuello del Útero.

“…En el Instituto del Cáncer de SOLCA Núcleo de Loja, como en todas las unidades de SOLCA del país, se ha adoptado como guía los Lineamientos NCCN del Instituto del Cáncer de EEUU [10]. Algunos centros oncológicos tienen protocolos que administran BT de entrada [11][12][13] En el presente estudio, se obtuvo una sobrevida libre de enfermedad a 5 años que se observa discretamente mejor a la reportada en los escasos resultados obtenidos en estudios similares, incluso considerando estadios de la enfermedad más tempranos [2][3][4][5]. Hanks y colaboradores [14] reporta una falla pélvica de 86 % en pacientes estadio III sometidas a TRT exclusiva, en comparación con la obtenida en los casos reportados del presente estudio en el mismo estadio.…”

“…Probablemente, se sigan presentando pacientes que sean candidatas para que reciban TRT exclusiva. Deberá optimizarse la infraestructura con el objeto de poder ofrecer terapia radiante con mejor distribución de dosis (Equipo de Megavoltaje de mayor energía), planificaciones de tratamiento en 3D, IMRT, Radioterapia externa convencional con boost concomitante [4] y, como lo dictan actualmente los lineamientos y protocolos, la asociación de Quimioterapia al esquema de tratamiento.…”

“…[3] Estos estudios también revelan un aumento progresivo del control local y la supervivencia, paralelo a un aumento progresivo de las dosis paracentrales (punto A) y la administración de tratamiento intracavitario. La tasa más alta de control central se observó con dosis paracentrales (punto A) mayores de 85 Gy [4,5]. Estos tumores en estadio IIIA y B se tratan con Radioterapia y Quimioterapia simultánea, los tumores en estadío IVB se tratan con Radioterapia y Quimioterapia paliativa.…”

IMRT and brachytherapy comparison in gynaecological cancer treatment: thinking over dosimetry and radiobiology

“…difficulty in cannulating the cervix) but also for the rapid fall-off of the dose in challenging scenarios, like bulky disease, irregular geometry of tumour or medical and logistic reasons [3,4]. Some authors have challenged the use of ICBRT by using EBRT [4][5][6][7][8]. Intensity-modulated radiation therapy (IMRT) can be an alternative approach to deliver a high dose to irregular and concave target volumes while reducing the volume of normal tissues irradiated.…”

“…Intensity-modulated radiation therapy (IMRT) can be an alternative approach to deliver a high dose to irregular and concave target volumes while reducing the volume of normal tissues irradiated. Moreover, some studies have already shown that IMRT can substitute ICBRT for boost dose delivery [6][7][8][9][10]. Likewise, the use of IMRT for whole-pelvis irradiation is now widely used and a decreased toxicity to the bowel and other critical structures has been reported with this technique [11][12][13][14][15][16].…”