Abstract
The purpose of this study was to evaluate the outcomes and toxicity experienced by cervical cancer patients with positive lymph nodes (LNs) who were treated with intensity-modulated radiation therapy (IMRT) and intracavitary brachytherapy (ICBT) plus concurrent chemotherapy. We retrospectively evaluated 108 cervical cancer patients with computed tomography (CT)-based positive LNs treated with IMRT and ICBT plus concurrent chemotherapy between 2009 and 2011. IMRT plans were designed to deliver 50 Gy to 95% of the planning target volume (PTV; cervical tumor, pelvis, and parametrium), with daily doses of 1.6–1.8 and 60–70 Gy to 95% of the planning gross tumor volume (PGTV)-LN (pelvic or para-aortic LNs), with daily doses of 2.0–2.2 Gy. Overall survival (OS) and progression-free survival (PFS) Kaplan–Meier curves were plotted. Acute and late toxicities were evaluated according to the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer toxicity criteria. Of the 108 cases, 45 were stage IIB and 63 were stage IIIB. The median follow-up was 65 months (range 2–83). Overall, the 5 year cumulative incidences of pelvic failure alone, distant failure alone, and synchronous pelvic and distant failure were 8.3, 12.9, and 8.3%, respectively. The 5 year OS rate was 67.6%, and the 5 year PFS rate was 53.7%. The 5 year cumulative incidence was 9.2% for late gastrointestinal and genitourinary toxicities of Grade ≥3 and 51.8% for acute leukopenia of Grade ≥3. The clinical results suggest that IMRT and ICBT with concurrent chemotherapy is an effective treatment, with acceptable toxicity, for advanced cervical cancer involving positive LNs.
Highlights
Over the past decades, numerous studies have shown that intensity-modulated radiation therapy (IMRT) and intracavitary brachytherapy (ICBT) with concurrent chemotherapy is a treatment option for patients with locally advanced cervical cancer [1, 2]
The median doses delivered to the planning target volume (PTV) and planning gross tumor volume (PGTV) were 50.4 and 61.6 Gy, respectively
It has been shown that a high proportion of cervical cancer patients with disease relapse have lymph nodes (LNs) metastases
Summary
Numerous studies have shown that intensity-modulated radiation therapy (IMRT) and intracavitary brachytherapy (ICBT) with concurrent chemotherapy is a treatment option for patients with locally advanced cervical cancer [1, 2]. Compared with conventional external beam radiation therapy (EBRT; using a 3–4-field box technique), the higher target conformity of IMRT helps to deliver a sufficient dose to locoregional lymph nodes (LNs) while limiting the dose delivered to pelvic and abdominal organs at risk (OARs), including the bowel, rectum, bladder, and bone marrow, thereby lowering the incidences of early and late gastrointestinal (GI), genitourinary (GU), and hematologic toxicity [3, 4]. Despite the promising results of IMRT for cervical cancer, outcome data remains limited. The effects of IMRT and ICBT with concurrent chemotherapy in women with cervical cancer and an intact uterus, for stage IIB and IIIB patients with positive LNs, remain unclear.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
