Abstract
Purpose: The aim of this study was to introduce the simultaneous integrated boost (SIB) technique to assess the safety of replacement of the brachytherapy (BT) boost for ineligible patients with cervical cancer receiving radiochemotherapy (RCT). Methods: Fourteen patients were enrolled between 2015 and 2018. SIB was delivered using RapidArc technique at doses of 2.4 Gy per fraction during pelvic irradiation with 50.4/1.8 Gy in seven patients (to a total dose of 67.2 Gy) with limited volume disease. In 7 patients with a more advanced disease stage (>5 cm tumor, parametric invasion both sides), parametric boost therapy was added to the pelvic radiotherapy to a total dose of the macroscopic tumor of 79.2 Gy. All patients received simultaneous cisplatin-based chemotherapy for 5 cycles with a dosage of 40 mg/m2. We examined acute toxicity (CTCAE v4.1) and quality of life (EORTC QLQ30 and CX24). The tumor regression rate was evaluated with RECIST 1.1 after the first 3- to 4-months follow-up Magnetic Resonance Imaging (MRI) scan. We calculated the percentage of tumor regression rate and the local control during the follow-up period and evaluated the survival data. Results: Our patient data are presented at a median follow-up time of 24.5 months. During the treatment period, no grade 3 to 4 toxicity was observed. During the follow-up period, no late-onset toxicity was observed. The tumor regression rate at the first MRI scan was 95.31% on average. Disease free survival (DFS) during the median follow-up of 24 months was 98.6%. Conclusion: In patients with cervical cancer, the SIB technique is amenable as part of definitive RCT. Dose escalation with the SIB technique can be safely administered to cervical cancer patients during definitive RCT if BT is not feasible. However, further randomized clinical studies are needed to validate the method, so routine use of it cannot be recommended yet.
Highlights
Cervical cancer accounts for 30% of all gynecological malignancies in the developed world
The aim of this study was to introduce the simultaneous integrated boost (SIB) technique to assess the safety of replacement of the brachytherapy (BT) boost for ineligible patients with cervical cancer receiving radiochemotherapy (RCT)
Treatment is performed most commonly using RCT as follows: percutaneous pelvic radiotherapy (RT) at a dose of 45 to 50.4 Gy using the 4-field box or IMRT technique at daily doses of 1.8 Gy per fraction, and pathological lymph nodes are boosted with SIB to 61,2 Gy with 2,2 Gy fractions, simultaneously with cisplatin chemotherapy at doses of 40 mg/m2 weekly in 4 to 5 cycles
Summary
Cervical cancer accounts for 30% of all gynecological malignancies in the developed world. Patients with cervical cancer classified as more advanced than FIGO stage Ib2 and stage T1b2 generally receive definitive radiochemotherapy (RCT). In these stages, treatment is performed most commonly using RCT as follows: percutaneous pelvic radiotherapy (RT) at a dose of 45 to 50.4 Gy using the 4-field box or IMRT (intensity modulated RT) technique at daily doses of 1.8 Gy per fraction, and pathological lymph nodes are boosted with SIB to 61,2 Gy with 2,2 Gy fractions, simultaneously with cisplatin chemotherapy at doses of 40 mg/m2 weekly in 4 to 5 cycles. According to the globally approved “gold standard,” 3 to 4 x 7 Gy image based intracavitary HDR-AL boost irradiation is performed at the end of the treatment. If the lesion is large combined intracavitary/interstitial implant is recomended [1, 2]
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