Efficacy and Toxicity of IMRT-Based Simultaneous Integrated Boost for the Definitive Management of Positive Lymph Nodes in Patients with Cervical Cancer

Dang, Yunzhi; Li, Pei; Li, Jianping; Zhang, Ying; Zhao, Lina; Li, Weiwei; Wei, Lichun; Shi, Mei

doi:10.7150/jca.29301

Cited by 28 publications

(40 citation statements)

References 28 publications

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“…The use of IMRT with SIB has greatly improved the quality of dose distribution, reducing treatment duration and allowing higher doses to reach target volumes in cervical cancer. 14–16…”

Section: Discussionmentioning

confidence: 99%

“…The recent introduction of intensity-modulated radiation therapy (IMRT) and its dynamic-volumetric applications with simultaneous integrated boost (SIB) allow delivery of different dose levels, achieving dose escalation to the target volumes and optimizing organs at risk (OARs), sparing overall treatment time, with possible applications for cervical cancer treatment. 14–16…”

Section: Introductionmentioning

confidence: 99%

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Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience

Boldrini

Piras

Chiloiro

et al. 2020

Tumori

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Objective: Magnetic resonance–guided radiotherapy (MRgRT) represents an innovative approach for personalized radiotherapy treatments and its applications are being explored in various anatomical sites to fully understand its potential advantages. This study describes the first clinical experience of MRgRT application in patients with locally advanced cervical cancer (LACC) undergoing neoadjuvant chemoradiotherapy. The feasibility of the technique is evaluated and its toxicity profile and clinical outcomes are reported. Methods: Patients with LACC (International Federation of Gynecology and Obstetrics stage IIA–IVA) undergoing neoadjuvant chemoradiotherapy (CRT) on a 0.35T Tri-60-Co hybrid unit (ViewRay) were retrospectively compared with randomly selected patients treated with a standard linear accelerator. Total prescribed dose was 50.6 Gy (2.3 Gy/fraction) to planning target volume 1 (PTV1) and 39.6 Gy (1.8 Gy/fraction) to PTV2, delivered using a simultaneous integrated boost. Surgery was performed 8 weeks after the end of CRT. The effect of magnetic resonance guidance on replanning approaches, treatment-related toxicities, and pathologic response were assessed for each patient. Patient outcomes were noted and dosimetric comparisons performed between the 2 arms. Results: Nine patients with LACC treated from May 2018 to November 2018 were retrospectively enrolled and their records compared with the records of an equivalent cohort of randomly selected patients. Five replanning cases were performed in the MRgRT group and 0 in the linear accelerator group. Acute G1–G2 gastrointestinal toxicities were observed in 33.3% of MRgRT patients and in 55.5% of linear accelerator patients; acute G1–G2 genitourinary toxicities in 22.2% and 33.3%, respectively. No G3 toxicity was found except for neutropenia in 2 patients. No differences were observed in pathologic response between the 2 groups. Conclusions: Despite the retrospective nature of the observations and the low number of enrolled patients, the application of MRgRT in LACC appears to be safe and feasible with a favorable toxicity profile and response rates comparable to gold standard, supporting the setup of larger prospective studies to investigate the potentialities of this new technology.

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“…The use of IMRT with SIB has greatly improved the quality of dose distribution, reducing treatment duration and allowing higher doses to reach target volumes in cervical cancer. 14–16…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience

Boldrini

Piras

Chiloiro

et al. 2020

Tumori

View full text Add to dashboard Cite

show abstract

“…Fabri [13] has reported no difference in adverse reactions between neoadjuvant chemotherapy and concurrent chemoradiotherapy. Dang et al [14] compared the complications of concurrent radiotherapy and chemotherapy with that of radiotherapy alone and found that concurrent radiotherapy and cisplatin-based chemotherapy could increase the therapeutic effect in cervical cancer patients and significantly improve the therapeutic benefit without increasing adverse reactions.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and prognostic factors of concurrent chemoradiotherapy in patients with stage Ib3 and IIa2 cervical cancer

et al. 2020

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Objectives: We investigated the efficacy, side effects, and prognostic factors of concurrent chemoradiotherapy for patients with stage Ib3-IIa2 cervical cancer. Material and methods: We conducted a retrospective analysis of clinicopathologic data from 73 patients with stage Ib3-IIa2 cervical cancer who received concurrent chemoradiotherapy from January 2008 to December 2013 in our hospital. Overall response and disease control rates were used to evaluate short-term outcomes; the 3-year and 5-year disease-free survival and overall survival were used to evaluate long-term efficacy. Toxicity reactions and prognostic factors were recorded. Results: With concurrent chemoradiotherapy, overall response and disease control rates were 91.78% and 97.26%, respectively. The 3-year disease-free and overall survival were 80.82% and 83.56%; the 5-year disease-free and overall survival were 75.34% and 79.45%, respectively. All side effects were tolerated and potentially alleviated by symptomatic treatment. Tumor pathological type, differentiated degree, primary tumor size and squamous cell carcinoma antigen levels before and after treatment were closely related to survival (univariate analysis; p < 0.05). Pathological type, primary tumor size and squamous cell carcinoma antigen levels one month after treatment were independent prognostic factors for long-term outcome (multivariate analysis). Conclusions: Short-and long-term efficacy of concurrent chemoradiotherapy for stage Ib3-IIa2 cervical cancer is well-determined and tolerable. Patients with adenocarcinomas, tumor diameter ≥ 5 cm and squamous cell carcinoma antigen levels ≥ 1.5 ng/mL (one month after treatment) had poor prognosis and should be assessed further.

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“…All patients received RT to the pelvis via IMRT using the Eclipse version 8.9 treatment planning system (Varian Medical, Palo Alto, CA). [ 21 ]…”

Section: Methodsmentioning

confidence: 99%

Intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar in patients with pelvic locoregional recurrence of cervical cancer

Wang¹,

Wang

et al. 2020

Medicine

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The treatment of recurrent cervical cancer, especially pelvic locoregional recurrence, is very challenging for gynecologic oncologists. This study investigated the efficacy and safety of intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar, a novel modified recombinant human endostatin, in patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.This phase 2 study was conducted between May 2018 and May 2019 at a single center in the Qinghai-Tibet Plateau and enrolled 31 patients with pelvic locoregional recurrence of cervical cancer following surgical treatment. All patients were treated with IMRT-based CCRT for 6 weeks and intravenous infusions of Endostar (15 mg/m 2 ), which were administered on days 1 to 7 of CCRT, followed by rest for 4 weeks. After resting, chemotherapy with cisplatin (70 mg/m 2 ) plus paclitaxel (135–175 mg/m 2 ) was given every 3 weeks for a total of 4 treatments.Thirty-one patients were evaluable for the primary endpoint. The mean age was 50.03 years (SD 7.72). The objective response rate was 67.74% and the disease control rate was 83.87% (48.39% achieved a complete response, 19.35% a partial response, 16.13% had disease stabilization, and 16.13% had progressive disease). The most common adverse events were nausea, vomiting, alopecia, neutropenia, and leukopenia; most events were grade 1 or 2 in intensity. Grade 3 toxicities included thrombocytopenia and neutropenia in 2 patients each, and leukopenia in 4 patients. No cases of grade 4 acute toxicity were observed. IMRT-based CCRT with Endostar infusions is effective and safe. Our results support the use of this treatment for patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.

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Efficacy and Toxicity of IMRT-Based Simultaneous Integrated Boost for the Definitive Management of Positive Lymph Nodes in Patients with Cervical Cancer

Cited by 28 publications

References 28 publications

Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience

Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience

Efficacy and prognostic factors of concurrent chemoradiotherapy in patients with stage Ib3 and IIa2 cervical cancer

Intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar in patients with pelvic locoregional recurrence of cervical cancer

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