Abstract
Considering internal organ motion and tumor regression, it is controversial to use intensity-modulated radiation therapy (IMRT) in definitive radiotherapy for cervical cancer. In this study, we evaluated the efficacy and toxicity of IMRT combined with dose-escalated intracavitary brachytherapy (ICBT) for cervical cancer. In total, 373 consecutive FIGO-stage-IIB cervical cancer patients treated with IMRT combined with ICBT and concurrent chemotherapy were included in this study. A dose of 50.4 Gy in 28 fractions was delivered to the pelvis for IMRT. Weekly cone-beam computed tomography or daily megavoltage computed tomography was used for image guiding. For ICBT, 30–36 Gy in five to seven fractions were prescribed to point A. All patients received concurrent chemotherapy. The median follow-up duration was 32.5 months (range, 3.1–119.8 months). The three-year overall survival, disease-free survival and local control rates were 87.5%, 82.2% and 92.5%, respectively. Sixty patients (16.1%) experienced treatment failure, including 23 patients (6.2%) with pelvic relapse. The incidences of ≥grade 3 chronic gastrointestinal and genitourinary toxicity were 2.7% and 2.4%, respectively. These findings indicate that image-guided IMRT combined with dose-escalated ICBT results in good survival with acceptable toxicity in stage IIB cervical cancer patients.
Highlights
Cervical cancer is the seventh-most-common cancer for women in China, and it was estimated that there were 98.9 thousand new cases and 30.5 thousand deaths in 2015 [1]
Treating cervical cancer patients with definitive intensity-modulated radiation therapy (IMRT) is risky, and sufficient margins should be added to the target volume
Large clinical target volume (CTV) margins may increase the dose to organs at risks (OARs) and decrease the disadvantages of IMRT
Summary
Cervical cancer is the seventh-most-common cancer for women in China, and it was estimated that there were 98.9 thousand new cases and 30.5 thousand deaths in 2015 [1]. The standard treatment approach for locally advanced cervical cancer is concurrent chemoradiotherapy (CCRT). External beam radiation therapy (EBRT) has been delivered via conventional radiotherapy or conformal radiation therapy (CRT), with anteroposterior and posteroanterior parallel portals or four-field “box” radiotherapy. These approaches deliver large irradiation volumes and cause considerable toxicity to the bladder, rectum and bowel. The Radiation Therapy Oncology Group 0418 trial demonstrated that IMRT reduced the toxicity of radiation therapy without worsening disease www.impactjournals.com/oncotarget control for postoperative International Federation of Gynecology and Obstetrics (FIGO) stage IA-IIB cervical cancer patients [2, 3]. IMRT is currently widely used for postoperative cervical cancer patients
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