Abstract
BackgroundThe purpose of this study is to report our clinical outcomes using intensity-modulated radiation therapy (IMRT) for adjuvant treatment of cervical cancer, compared with three-dimensional conformal radiation therapy (3DCRT), in terms of tumor control, complications and dose-volume histogram (DVH) parameters.MethodsBetween March 2008 and February 2014, 62 patients were treated with concurrent nedaplatin-based chemotherapy and whole-pelvic external beam radiation therapy (RT). Of these patients, 32 (52 %) received 3DCRT and 30 (48 %) received IMRT.ResultsThe median follow-up periods were 40 months (range 2–74 months). The 3-year overall survival rate (OS), locoregional control rate (LRC) and progression-free survival rate (PFS) were 92, 95 and 92 % in the IMRT group, and 85, 82 and 70 % in the 3DCRT group, respectively. A comparison of OS, LRC and PFS showed no significant differences between IMRT and 3DCRT. The 3-year cumulative incidences of grade 2 or higher chronic gastrointestinal (GI) complications were significantly lower with IMRT compared to 3DCRT (3 % vs. 45 %, p < .02) and in patients with V40 of the small bowel loops of ≤340 mL compared to those with >340 mL (3 % vs. 45 %, p < .001). Patients treated with IMRT had a higher incidence of grade 3 acute hematologic complications (p < .05). V40 and V45 of the small bowel loops or bowel bag were predictive for development of both acute and chronic GI complications.ConclusionsOur results suggest that IMRT for adjuvant treatment of cervical cancer is useful for decreasing GI complications without worsening outcomes.
Highlights
The purpose of this study is to report our clinical outcomes using intensity-modulated radiation therapy (IMRT) for adjuvant treatment of cervical cancer, compared with three-dimensional conformal radiation therapy (3DCRT), in terms of tumor control, complications and dose-volume histogram (DVH) parameters
We previously reported that dose-volume histogram (DVH) parameters of the small bowel loops were predictive for development of chronic GI complications and that V40 of the small bowel loops >340 mL was an independent risk factor for chronic GI complications using conventional two-dimensional (2D) or threedimensional (3D) conformal RT (CRT) concurrently with nedaplatin [4]
The 3-year cumulative incidences of grade 2 or higher chronic GI complications were significantly lower with IMRT compared to Three-dimensional conformal radiation therapy (3DCRT) (3 % vs. 45 %, HR = 7.5, 95 % confidence interval (CI) = 1.2-15.0, p < .02) and in patients with V40 of the small bowel loops of ≤340 mL compared to those with >340 mL (3 % vs. 45 %, HR = 7.7, 95 % CI = 3.2-61.0, p < .001) (Fig. 3)
Summary
The purpose of this study is to report our clinical outcomes using intensity-modulated radiation therapy (IMRT) for adjuvant treatment of cervical cancer, compared with three-dimensional conformal radiation therapy (3DCRT), in terms of tumor control, complications and dose-volume histogram (DVH) parameters. We previously reported that dose-volume histogram (DVH) parameters of the small bowel loops were predictive for development of chronic GI complications and that V40 of the small bowel loops >340 mL was an independent risk factor for chronic GI complications using conventional two-dimensional (2D) or threedimensional (3D) conformal RT (CRT) concurrently with nedaplatin [4]. The purpose of this study is to report our clinical outcomes using IMRT for adjuvant treatment of cervical cancer, compared with 3DCRT, in terms of tumor control and complications. We evaluated whether DVH predictors for development of GI complications using 2D or 3DCRT were useful parameters in IMRT
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