Abstract
BackgroundTo assess the safety and efficacy of simultaneous integrated boost (SIB) or late course accelerated boost (LCAB) with external beam radiotherapy (EBRT) to the vaginal cuff for high risk cervical cancer patients after radical hysterectomy.MethodsBetween October 2009 and January 2012, patients with high risk cervical cancer who had undergone radical surgery followed by EBRT to the vaginal cuff were enrolled. Patients were treated with either intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with SIB (arm A) or IMRT/VMAT to the pelvis followed by LCAB (arm B) to vaginal cuff. In arm A, the pelvic and boost doses were 50.4 Gy and 60.2 Gy in 28 fractions, respectively. In arm B, pelvic irradiation to 50 Gy in 25 fractions followed by a boost of 9 Gy in 3 fractions were delivered. Chemotherapy was given concurrently.ResultsOverall, 80 patients were analyzed in this study (42 in arm A, 38 in arm B). In arm A and B, median follow-up was 37 and 32 months, respectively. The 3-year disease-free survival and overall survival in arms A vs B were 88.7% vs. 93.4% (p = 0.89), and 91.8% vs.100% (p = 0.21), respectively. The 3-year local-regional control and distant failure were 97.6% vs. 100% (p = 0.34), and 4.8% vs. 5.3% (p = 0.92), respectively. Grade 3–4 acute leukopenia and dermatitis were seen in 11 (26.2%) and 8 (19.0%) patients in Arm A, vs. 7 (17.8%) and 6 (15.8%) patients in Arm B, respectively (p > 0.05). Only Grade 1–2 chronic gastrointestinal (GI) and genitourinary (GU) toxicities were observed.ConclusionsOur results indicate that both SIB and LCAB to vaginal cuff for high risk cervical cancer patients after radical hysterectomy are associated with excellent survival, local control and low toxicity.
Highlights
To assess the safety and efficacy of simultaneous integrated boost (SIB) or late course accelerated boost (LCAB) with external beam radiotherapy (EBRT) to the vaginal cuff for high risk cervical cancer patients after radical hysterectomy
The purpose of this study is to report a singleinstitution experience using adjuvant EBRT to boost the vaginal cuff in high risk cervical cancer patients after radical hysterectomy, and compare two techniques for doing so, simultaneous integrated boost (SIB) with intensity-modulated radiotherapy (IMRT)/ volumetric-modulated arc therapy (VMAT) and late course accelerated boost (LCAB) following pelvic IMRT/VMAT
The EBRT boost to vaginal cuff was delivered as either IMRT/VMAT SIB or IMRT/VMAT to the pelvis followed by LCAB with 3D-CRT at the Department of Abdominal Oncology of West China Hospital of Sichuan University
Summary
To assess the safety and efficacy of simultaneous integrated boost (SIB) or late course accelerated boost (LCAB) with external beam radiotherapy (EBRT) to the vaginal cuff for high risk cervical cancer patients after radical hysterectomy. With the rapid development of recent EBRT techniques, such as intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT), three dimensional- conformal radiotherapy (3D-CRT) andstereotactic radiotherapy, a radiation boost to the vaginal cuff and parametria can be achieved. Some studies explored these EBRT boost methods in patients with locally advanced cervical or endometrial cancer, and reported that delivering a total dose of 54–81.2 Gy was well tolerated and efficacious [8-12]
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