Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience.

Yanzhu Lin,Xinping Cao,Yonghong Liu,Yi Ouyang,Kai Chen,Zhiyuan Lu

doi:10.3389/fonc.2019.00760

Abstract

Purpose: To evaluate treatment outcomes and toxicity in patients with cervical cancer (CC) treated with volumetric modulated arc therapy (VMAT), followed by three-dimensional high-dose-rate intracavity combined with interstitial brachytherapy (IC/IS BT) compared with intensity-modulated radiation therapy (IMRT) treatment.Materials and Methods: A total of 398 patients with stage IA–IVB CC treated with definitive radiotherapy with or without chemotherapy were retrospectively analyzed (331 VMAT and 67 IMRT). A total prescription dose of 45–50 Gy was delivered to pelvic field with VMAT/IMRT in 25/28 fractions, with five fractions per week. Every patient further received IC/IS BT for four to six 6.0-Gy fractions. Local control (LC), disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) rates were calculated. Acute hematotoxicity and late toxicity were recorded.Results: The median follow-up period was 25.47 (range, 0.93–58.93) months for the VMAT and 35.07 (4.8–90.37) months for IMRT. The 3-year OS, DFS, LC, and DMFS rate were 80.5, 65.4, 88.7, and 78.1% in VMAT group, and 76.2, 76.4, 83.1, and 86.1% in the IMRT group, respectively. No significant differences were found between VMAT and IMRT groups for OS, DFS, LC, and DMFS rate. However, patients in the VMAT group had lower incidence of chronic enterocolitis complication (26.6 vs. 38.8%, p = 0.004). In addition, a total of 3 (0.9%) patients developed grade 3 chronic cystitis, and 7 (2.1%) patients developed grade 3 or greater chronic enterocolitis in VMAT group.Conclusion: VMAT combined with IC/IS BT can result in satisfactory curative outcomes and low incidences of late radiation enterocolitis and cystitis in CC treatment.

Highlights

Cervical cancer (CC) is the forth most common cancer in women worldwide [1], with an incidence of 98,900 cases and 30,500 deaths annually in China [2]
No significant differences were found between Volumetric modulated arc therapy (VMAT) and Intensity-modulated RT (IMRT) groups for overall survival (OS), disease-free survival (DFS), Local control (LC), and distant metastasis-free survival (DMFS) rate
VMAT combined with IC/IS BT can result in satisfactory curative outcomes and low incidences of late radiation enterocolitis and cystitis in CC treatment

Summary

Introduction

Cervical cancer (CC) is the forth most common cancer in women worldwide [1], with an incidence of 98,900 cases and 30,500 deaths annually in China [2]. Definitive RT, including external beam RT (EBRT) and brachytherapy (BT) combined with concurrent chemotherapy, is the main treatment modality for patients with stage IIB–IVA CC [3]. Intensity-modulated RT (IMRT) is a technique that enables greater conformity and uniform dose distribution to a tumor, reducing damage to surrounding normal tissues [4]. IMRT can be used to achieve excellent treatment outcomes for CC as well as to effectively reduce side effects such as radioactive cystitis and enteritis [5]. Volumetric modulated arc therapy (VMAT) is an advanced form of IMRT; VMAT results in greater conformity and shorter treatment delivery time compared with IMRT [6]. Definitive VMAT has been used since 2012 for treating patients with CC. Data on the efficacy of definitive VMAT in the treatment of CC are limited

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Conclusion