EBRT Modality-Specific Treatment Outcome of Cervical Cancer Patients for Real-World Practice

Abstract

Purpose: To compare the clinical outcome while treating cervical cancer patients with intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT). Methods: Analyzed a very large dataset from real-world practice using the National Cancer Database (NCDB) for FIGO IB-IIIB inoperable cervical cancer patients treated with chemoradiation from 2004 to 2014. Patients who received initial treatment with external beam radiation therapy (EBRT), either IMRT or 3DCRT, of 40-60Gy dose were included. Patients who received EBRT boost were stratified based on treatment modality (IMRT or 3DCRT for initial and boost). Also considered another group where EBRT is followed by brachytherapy, i.e. the standard of care. IBM-SPSS was used for statistical analysis; p-value <0.05 was considered statistically significant. Results: Median age of the eligible patient population was 53 years and the median follow-up was 24.4 months. Analysis revealed that the median OS was 36.1 months for IMRT versus 51.2 months for 3DCRT (p <0.05); 2- and 5-year OS were 7% and 9%, higher for 3DCRT (p <0.007). Conclusion: This study demonstrates 3DCRT was better than IMRT for OS when no brachytherapy boost was considered. However, 3DCRT and IMRT did not make any difference in OS when brachytherapy boost was used. Therefore, it is important to use brachytherapy boost whenever possible for treatment of inoperable cervical cancer patients with curative intent.