Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer

Abstract

The goal of this work was to evaluate the feasibility and outcome of intensity-modulated arc therapy ±cisplatin (IMAT±C) followed by hysterectomy for locally advanced cervical cancer. A total of 30patients were included in the study. The primary tumour and PET-positive lymph node(s) received a simultaneous integrated boost. Four weeks after IMAT±C treatment, response was evaluated. Resection consisted of hysterectomy with or without lymphadenectomy. Tumour response, acute and late radiation toxicity, postoperative morbidity and outcome were evaluated. All hysterectomy specimens were macroscopically tumour-free with negative resection margins; pathological complete response was 40%. In 2patients, one resected lymph node was positive. There was no excess in postoperative morbidity. Apart from two grade 3 hematologic toxicities, no grade3 or 4 acute radiation toxicity was observed. No grade3, 1 grade4 (4%) intestinal, and 4 grade3 (14%) urinary late toxicities were observed. The 2-year local and regional control rates were 96% and 100%, respectively. The 2-year distant control rate was 92%. Actuarial 2-year progression free survival rate was 89%. Actuarial 1- and 2-year overall survival rates were 96% and 91%, while 3-year overall survival was 84%. Surgery after IMAT±C is feasible with low postoperative morbidity and radiation toxicity. Local, regional, distant control and survival rates are promising.