IMAT-IGRT Treatment with Simultaneous Integrated Boost as Dose Escalation for Patients with Cervical Cancer: A Single Institution, Prospective Pilot Study

Abstract

Purpose: The aim of this study was to introduce the simultaneous integrated boost (SIB) technique to assess the safety of replacement of the brachytherapy (BT) boost for ineligible patients with cervical cancer receiving radiochemotherapy (RCT).Methods: Fourteen patients were enrolled between 2015 and 2018. SIB was delivered using RapidArc technique at doses of 2.4 Gy per fraction during pelvic irradiation with 50.4/1.8 Gy in seven patients (to a total dose of 67.2 Gy) with limited volume disease. In 7 patients with a more advanced disease stage (>5 cm tumor, parametric invasion both sides), parametric boost therapy was added to the pelvic radiotherapy to a total dose of the macroscopic tumor of 79.2 Gy. All patients received simultaneous cisplatin-based chemotherapy for 5 cycles with a dosage of 40 mg/m2. We examined acute toxicity (CTCAE v4.1) and quality of life (EORTC QLQ30 and CX24). The tumor regression rate was evaluated with RECIST 1.1 after the first 3- to 4-months follow-up Magnetic Resonance Imaging (MRI) scan. We calculated the percentage of tumor regression rate and the local control during the follow-up period and evaluated the survival data.Results: Our patient data are presented at a median follow-up time of 24.5 months. During the treatment period, no grade 3 to 4 toxicity was observed. During the follow-up period, no late-onset toxicity was observed. The tumor regression rate at the first MRI scan was 95.31% on average. Disease free survival (DFS) during the median follow-up of 24 months was 98.6%.Conclusion: In patients with cervical cancer, the SIB technique is amenable as part of definitive RCT. Dose escalation with the SIB technique can be safely administered to cervical cancer patients during definitive RCT if BT is not feasible. However, further randomized clinical studies are needed to validate the method, so routine use of it cannot be recommended yet.

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

“…In addition, many national-and state-level databases have shown a substantial disparity in the accessibility to healthcare services and the use of BT boost among individuals diagnosed with cervical cancer in the United States. Referring to the simultaneous integrated boost (SIB), Lőcsei [99] showed that SIB is suitable for decisive RCTs in cervical cancer patients. If BT is not possible, SIB dose escalation may safely be given to cervical cancer patients throughout final RCT.…”

Comparison of Online-Onboard Adaptive Intensity-Modulated Radiation Therapy or Volumetric-Modulated Arc Radiotherapy With Image-Guided Radiotherapy for Patients With Gynecologic Tumors in Dependence on Fractionation and the Planning Target Volume Margin

“…Prospective trials of definitive radiochemotherapy for locally advanced cervical carcinomas or recurrences after surgery found that up to 20% or more of enrolled patients may have tumors that are unsuitable for a brachytherapy boost . Image-guided radiotherapy (IGRT) as a boost or as definitive treatment can be delivered either as conventionally fractionated or hypofractionated radiotherapy for these patients . However, higher-grade gastrointestinal toxic effects were found in some studies and only limited mature outcome data of this approach are currently available …”

“…[1][2][3][4] Image-guided radiotherapy (IGRT) as a boost or as definitive treatment can be delivered either as conventionally fractionated or hypofractionated radiotherapy for these patients. [5][6][7][8][9] However, higher-grade gastrointestinal toxic effects were found in some studies 5 and only limited mature outcome data of this approach are currently available. 10 The linear accelerator ETHOS (Varian Medical Systems) represents a new generation of radiotherapy linear accelerators.…”