3D conformal HDR-brachy- and external beam therapy plus simultaneous Cisplatin for high-risk cervical cancer: Clinical experience with 3 year follow-up

Abstract

Background and purposeTo assess feasibility, safety and effectiveness of CT–based 3D conformal external beam radiotherapy (EBRT) plus concurrent cisplatin and MRI–based 3D conformal HDR-brachytherapy (HDR-BT) in the treatment of advanced cervical cancer. Patients and methodsA total of 48 patients with advanced cervical cancer, treated with CT–based EBRT plus simultaneous cisplatin chemotherapy (40mg/m2 of body surface per week for 5 weeks) and MRI–based HDR-BT, were included for analysis. ResultsAll patients completed radiotherapy as planned and 90% received at least four cycles chemotherapy. Frequencies of CTC grade 3 anaemia, grade 3–4 leucopenia and grade 3 thrombocytopenia were 4, 23 and 10%, respectively. Two patients developed deep vein thrombosis and one non-fatal pulmonary embolism. Grade 4 genitourinary late side effects (bladder) occurred in 2 patients. No grade 3–4 gastrointestinal side effects were observed. Complete response (CR) was obtained in 45 patients (94%). After a median follow-up of 33 months, 27 patients were disease free. Actuarial overall survival at 3 years was 61%, progression free survival 51% and continuous complete remission for true pelvis 85%. ConclusionsMRI–based 3D HDR-BT and 3D EBRT plus cisplatin appears to be safe and effective, although acute haematological toxicity is increased. Gastrointestinal morbidity is minimal when prospectively applying 3D dose volume constraints and MRI–based 3D dose volume adaptation.