Conventional 3D conformal radiotherapy and volumetric modulated arc therapy for cervical cancer: Comparison of clinical results with special consideration of the influence of patient- and treatment-related parameters

Leif Hendrik Dröge,Markus Anton Schirmer,Franziska-Felicitas Von Sivers,Hendrik Andreas Wolff

doi:10.1007/s00066-021-01782-5

Leif Hendrik Dröge, Markus Anton Schirmer + Show 2 more

Open Access

https://doi.org/10.1007/s00066-021-01782-5

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Abstract

PurposeIntensity-modulated radiotherapy (IMRT) for cervical cancer yields favorable results in terms of oncological outcomes, acute toxicity, and late toxicity. Limited data are available on clinical results with volumetric modulated arc therapy (VMAT). This study’s purpose is to compare outcome and toxicity with VMAT to conventional 3D conformal radiotherapy (3DCRT), giving special consideration to the influence of patient- and treatment-related parameters on side effects.Materials and methodsPatients with cervical cancer stage I–IVA underwent radiotherapy alone or chemoradiotherapy using 3DCRT (n = 75) or VMAT (n = 30). Survival endpoints were overall survival, progression-free survival, and locoregional control. The National Cancer Institute Common Terminology Criteria for Adverse Events and the Late Effects of Normal Tissues criteria were used for toxicity assessment. Toxicity and patient- and treatment-related parameters were included in a multivariable model.ResultsThere were no differences in survival rates between treatment groups. VMAT significantly reduced late small bowel toxicity (OR = 0.10, p = 0.03). Additionally, VMAT was associated with an increased risk of acute urinary toxicity (OR = 2.94, p = 0.01). A low body mass index (BMI; OR = 2.46, p = 0.03) and overall acute toxicity ≥grade 2 (OR = 4.17, p < 0.01) were associated with increased overall late toxicity.ConclusionWe demonstrated significant reduction of late small bowel toxicity with VMAT treatment, an improvement in long-term morbidity is conceivable. VMAT-treated patients experienced acute urinary toxicity more frequently. Further analysis of patient- and treatment-related parameters indicates that the close monitoring of patients with low BMI and of patients who experienced relevant acute toxicity during follow-up care could improve late toxicity profiles.

Highlights

Radiotherapy and chemoradiotherapy (RT/CRT) reduce local and distant recurrence and improve survival in cervical cancer [1, 2], not seldom at the expense of side effects [3,4,5,6]
A few studies have reported favorable toxicity profiles or promising outcomes with volumetric modulated arc therapy (VMAT), whereby these studies focused on adjuvant treatment [15], neoadjuvant treatment [16], or treatment in elderly patients [17]
8 patients were irradiated with intensity-modulated radiotherapy (IMRT)

Summary

Introduction

Radiotherapy and chemoradiotherapy (RT/CRT) reduce local and distant recurrence and improve survival in cervical cancer [1, 2], not seldom at the expense of side effects [3,4,5,6]. Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) were introduced into radiation oncology practice [7, 8]. IMRT was demonstrated to achieve favorable results in terms of oncological outcomes and toxicity [9,10,11,12]. VMAT, at the planning level, achieved excellent dose distributions [13, 14]. A few studies have reported favorable toxicity profiles or promising outcomes with VMAT, whereby these studies focused on adjuvant treatment [15], neoadjuvant treatment [16], or treatment in elderly patients [17]. Comparisons of VMAT with other external beam radiotherapy (EBRT) techniques are still rare [18]

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