Abstract
5027 Background: Intensity modulated pelvic radiation therapy (IM-PRT) is receiving increasing attention in gynecology. Numerous investigators have shown that IM-PRT reduces the volume of normal tissues irradiated compared to conventional pelvic RT. Recent studies have noted less toxicity in pts receiving IM-PRT. No data, however, exist regarding tumor control using IM-PRT. We present our experience using IM-PRT in stage I-II cervical cancer. Methods: Between 2/00 and 2/03, 34 stage I-II cervical cancer pts received IM-PRT. 21pts (12 IB, 9 IIA-IIB) with an intact uterus underwent IM-PRT (20 received weekly cisplatin) followed by brachytherapy, and in 6, simple hysterectomy. 13 stage I pts underwent surgery and received IM-PRT due to adverse features (lymphatic invasion, tumor >4 cm, positive nodes). 6 also received chemotherapy and 2 brachytherapy. On a contrast-enhanced CT scan, a clinical target volume was contoured consisting of the upper vagina, parametria, uterus (if present), presacral and pelvic lymph nodes, and was expanded by 1 cm creating a planning target volume (PTV). IM-PRT plans were generated using inverse planning. Pts were followed with physical exams, cytology, and CT scans. Late toxicity was graded using the RTOG/EORTC scale. Results: IM-PRT plans were highly conformal, with excellent PTV coverage and considerable sparing of the small bowel, bladder and rectum. At a median follow-up of 26.4 months, 5 pts (15%) have recurred, for a 3-year actuarial disease-free survival of 82%. All 5 recurred in extra-pelvic sites. One pt (2.9%) recurred in the pelvis, for a 3-year actuarial pelvic control (PC) of 95%. This pt had stage IIB disease. The 3-year PC of pts with an intact uterus and those treated adjuvantly were 91% and 100%. No pt developed grade ≥ 2 gastrointestinal (GI) or genitourinary (GU) sequelae (2 had grade 1 GI and 1 grade 1 GU toxicity). Conclusions: Stage I-II cervical cancer pts treated with IM-PRT have an excellent tumor control and low rate of toxicity. These results represent the first outcome report of gynecology pts treated with IM-PRT. Larger numbers and longer follow-up are needed to confirm these encouraging results. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Varian, Inc.
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