Does initial 45Gy of pelvic intensity-modulated radiotherapy reduce late complications in patients with locally advanced cervical cancer? A cohort control study using definitive chemoradiotherapy with high-dose rate brachytherapy

Abstract

BackgroundComparing initial 45 Gy of pelvic intensity-modulated radiation therapy (IMRT) and non-IMRT in terms of the late toxicities associated with advanced cervical cancer that has also been treated with definitive concurrent chemoradiotherapy and high-dose rate intracavitary brachytherapy (HDRICB).Patients and methods This retrospective study included 320 stage IB2-IIIB cervical cancer patients treated with CCRT (83 IMRT and 237 non-IMRT). The two groups had similar stage and HDRICB ratings. Following 45 Gy to the pelvis, HDRICB of 24 Gy in four courses was prescribed. Late toxicities, including rectal complications (RC), bladder complications (BC) and non-rectal intestinal injury (NRRII), were scored by the Common Terminology Criteria for Adverse Events. A logistic regression was used to estimate the odds ratio (OR) of the complications.ResultsWith a median follow-up duration of 33 and 77 months for IMRT and non-IMRT, 33 patients had Grade 2 or higher late RC (7.2% IMRT, 11.4% non-IMRT), whereas that for BC was 40 (9.6% IMRT, 13.5% non-IMRT) and for NRRII was 48 (12.0% IMRT, 16.0% non-IMRT). The cumulative rate for total grade 3 or higher gastrointestinal or genitourinary toxicities was 8.4% and 11.8% (p = 0.33). IMRT did not reduce the OR for all endpoints; however, the ORs for rectum and bladder reference doses to Point A were associated with RC and BC.ConclusionsLocally advanced cervical cancer patients treated with initial 45Gy of pelvic IMRT and HDRICB have similar treatment-related late toxicities as those treated with non-IMRT. Optimization of the brachytherapy scheme is essential to minimize late toxicities.

Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis

“…Our meta-analysis revealed that the frequency of acute grade 2–4 GI and GU toxicities and of chronic grade 3 GU toxicity was significantly lower in the IMRT group than it was in the control group. One study [ 10 ] did not provide the grades of toxicity and thus was not included in this portion of our analysis. A preliminary study indicated that IMRT was associated with less chronic GI toxicity than c-RT was in patients with gynaecologic malignancies [ 21 ].…”

Textural features of cervical cancers on FDG-PET/CT associate with survival and local relapse in patients treated with definitive chemoradiotherapy

“…As previously described 31 , the clinical target volume (CTV) included the gross disease, cervix, parametrium, uterus, superior half of the vagina, cardinal ligament, presacral region, and regional lymph nodes (common, internal, and external iliac). The planning target volume (PTV) was extended from the CTV to account for organ motion and setup uncertainty.…”

“…Chemotherapy consisted of cisplatin administered weekly at a dose of 40 mg/m 2 intravenously, for a maximal dose of 60 mg. The detailed drug administration protocol has been described in our previous study 31 . Chemotherapy was withheld if we observed any hematological toxicity of more than or equal to grade 3.…”

The Treatment of Pelvic Locoregional Recurrence of Cervical Cancer After Radical Surgery With Intensity-Modulated Radiation Therapy Compared With Conventional Radiotherapy: A Retrospective Study

“…For the treatment of gynecologic cancers, most reports have shown that IMRT reduces bladder, bowel, rectal, and bone marrow dose and is associated with favorable clinical outcomes such as lower rates of acute GI, GU, and hematologic toxicity after whole-pelvic radiation therapy. 16,17 In this study, we compared IMRT and c-RT treatment plans in patients with postoperative recurrent cervical cancer, with respect to both tumor dose conformality and critical normal tissue avoidance. Our results showed that IMRT produced an obvious improvement in the conformality relative to the c-RT techniques (0.680 T 0.067 vs 0.300 T 0.054).…”