Adaptive VMAT Radiotherapy to Avoid Brachytherapy in Cervical Cancer Treatment

Abstract

<h3>Purpose/Objective(s)</h3> Concomitant chemoradiation (CRT) is the standard of care to treat patients with stage Ib1- IVb carcinoma of the cervix. External beam radiotherapy (EBRT) and brachytherapy are used. There are potential benefits of VMAT technology both in terms of an escalation of dosage and a decrease in toxicity. Non-brachytherapy treatment is an evolving alternative approach which requires adaptive external beam radiotherapy treatment to improve its accuracy and to avoid geographical miss, yet it is still unclear whether this approach could yield further improve outcomes. <h3>Materials/Methods</h3> A Prospective study was conducted between May 2015 and May 2021. Thirty-two patients with locally advanced cervical cancer (LACC) stage Ib1-IVa and three patients with stage IVb who underwent CRT using EBRT and simultaneous integrating boost (SIB) were evaluated. The median age was 53,2 years (30-76) with prevalence of squamous cell carcinoma histology (80 %). All patients had regular follow-up by gynecological examination, pelvis MRI and 18FDG-PET/CT scan. The prescribed radiation dose ranged between 60,0 to 96,6 Gy to the gross tumor volume (GTV). None of these patents received brachytherapy treatment, and eight (22,8%) patients received no chemotherapy due to other reasons. <h3>Results</h3> A total of 35 patients were recruited. The median follow-up was 38 months (range: 2-83 months). The 1, 3 and 5-year overall survival and local control were 91, 78, 74% and 100, 97, 94%, respectively. Six patients had disease progression. The median time to progression was 9 months (range: 3-16 months). Early and late toxicities were acceptable without severe events. <h3>Conclusion</h3> Non brachytherapy CRT treatment of LACC is feasible and seems that escalating the dosage provides better local control, which might be translated to favor progression free and overall survival. No serious toxicities occur and studies to establish this method are mandatory.