Abstract
We evaluate the outcomes of irradiation by using three-dimensional radiation therapy (3D-RT) or intensity-modulated radiotherapy (IMRT) for recurrent and metastatic cervical cancer. Between 2007 and 2010, 50 patients with recurrent and metastatic cervical cancer were treated using 3D-RT or IMRT. The median time interval between the initial treatment and the start of irradiation was 12 (6–51) months. Salvage surgery was performed before irradiation in 5 patients, and 38 patients received concurrent chemotherapy. Sixteen patients underwent 3D-RT, and 34 patients received IMRT. Median follow-up for all the patients was 18.3 months. Three-year overall survival and locoregional control were 56.1% and 59.7%, respectively. Three-year progression-free survival and disease-free survival were 65.3% and 64.3%, respectively. Nine patients developed grade 3 leukopenia. Grade 5 acute toxicity was not observed in any of the patients; however, 2 patients developed Grade 3 late toxicity. 3D-RT or IMRT is effective for the treatment of recurrent and metastatic cervical cancer, with the 3-year overall survival of 56.1%, and its complications are acceptable. Long-term follow-up and further studies are needed to confirm the role of 3D-RT or IMRT in the multimodality management of the disease.
Highlights
Despite improvements in the outcomes of single or combined modality treatment for achieving higher local control of cervical cancer, locoregional recurrences or distant metastasis after initial treatment remain a major therapeutic challenge
The median dose for planning target volume (PTV) in 37 patients without direct tumor boost was 50 Gy
Reports on 3D-RT or intensity-modulated radiotherapy (IMRT) have been increasingly published in recent years, majority of studies have focused on locally advanced cervical cancer or whole pelvic radiotherapy after radical surgery, while few have addressed recurrent and metastatic disease
Summary
Despite improvements in the outcomes of single or combined modality treatment for achieving higher local control of cervical cancer, locoregional recurrences or distant metastasis after initial (surgical or radiation) treatment remain a major therapeutic challenge. A 10–20% recurrence rate has been reported following primary surgery or radiotherapy in women with stage IB–IIA cervical tumors. Recent phase III trial has documented response rates of 29.1%, 25.9%, 22.3% and 23.4% when cisplatin has been combined with paclitaxel, vinorelbine, gemcitabine and topotecan, respectively [5]. Despite these encouraging results, most of the responses are partial and of short duration
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