Abstract
BackgroundTo evaluate toxicity and outcome of intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the positive lymph nodes in patients with loco-regional advanced cervical cancer (LRACC).MethodsThe study population comprised ten patients with 18FDG-PET\\CT positive lymph nodes (LNs), who underwent chemoradiation with IMRT and SIB. A dose of 50.4 Gy, in daily fractions of 1.8 Gy, was delivered to primary tumor and draining LNs. Primary tumor received an additional external beam boost to a total dose of 55.8 Gy. A SIB of 62 Gy, in daily fractions of 2 Gy, was delivered to the 18FDG-PET\\CT positive LNs. Finally, a high dose rate brachytherapy (HDRB) boost (15 – 18 Gy) was administered to the primary tumor. The primary goal of this study was to evaluate acute and early late toxicity and loco-regional control.ResultsThe median number of irradiated LNs per patient was 3 (range: 1–6) with a median middle nodal SIB-volume of 26.10 cm3 (range, 11.9-82.50 cm3). Median follow-up was 20 months (range, 12 to 30 months). Acute and late grade 3 toxicity was observed in 1 patient. Three of the patients developed a recurrence, one in the form of a local tumor relapse, one had a paraaortic LN metastasis outside the treated volume and the last one developed a distant metastasis.ConclusionIMRT with SIB in the region of 18FDG-PET positive lymph nodes appears to be an effective therapy with acceptable toxicity and might be useful in the treatment of patients with locally advanced cervical cancer.
Highlights
To evaluate toxicity and outcome of intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the positive lymph nodes in patients with loco-regional advanced cervical cancer (LRACC)
Besides improving the therapeutic ratio, IMRT is capable of delivering different doses to different parts of the irradiated volume through dose painting or a simultaneous integrated boost (SIB) – a concept which has been studied in different tumor entities
Due to the many advantages of IMRT, we have developed a protocol addressing the treatment of 18FDG-PET \computed tomography (CT) positive Lymph node (LN) using a SIB technique
Summary
To evaluate toxicity and outcome of intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the positive lymph nodes in patients with loco-regional advanced cervical cancer (LRACC). Methods: The study population comprised ten patients with 18FDG-PET\CT positive lymph nodes (LNs), who underwent chemoradiation with IMRT and SIB. The primary goal of this study was to evaluate acute and early late toxicity and loco-regional control. In the absence of systemic metastasis, the most important predictive factor is the loco-regional LN status [4,5,6]. These facts lead to the hypothesis that effective treatment of loco-regional disease results in better disease control and longer survival. Several authors have evaluated the use of SIB in the treatment of cervical cancer in preoperative settings and dose escalation in the parametric region [10,11,12,13,14]
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