Abstract
e16520 Background: To analyze the dosimetry features of adaptive IMRT integrated 3D-HDR brachytherapy in local advanced cervical carcinoma and report its preliminary clinical results. Methods: From 2009.06 to 2012.06, patients with cervical carcinoma (IIb-IIIb by FIGO staging) in Sichuan Cancer Hospital were treated with IMRT firstly in a 45Gy/25f/5w fraction modal, replanning at 30Gy adapting to the volume alterations of cervical lesions. Subsequently, adaptive IMRT integrated 3D-HDR brachytherapy was applied to boost the dosage of residual cervical lesions, MRI/CT scanning and replanning for each fraction, 6 (8Gy/f×4) 6f. Concurrent chemotherapy with DDP 40 mg/m2, was used weekly in the full course. The DVH data were collected for dosimetry analysis. The acute and late side effects, early responses and long term efficacy were evaluated for these group of patients. Results: Seventy-nine patients with local advanced cervical cancer were recruited in this study with a median age of 50yr (29-70yr) and median follow-up of 25mons (6-34mons). Dosimetry analysis demonstrated that IMRT-HDR not only yielded substantially improved high-risk CTV coverage (average V95 = 96.2%), but also kept the doses to the bladder (D1cc 69 (76Gy) and rectum(D1cc 63 (70Gy) reasonably low. Out of this group of patients, 87.8% reached complete response (CR) and 12.2% partial response (PR). Two-year follow-up showed that local control rate (LC), distant-metastasis free survival rate (DMFS), overall survival rate (OS) was 93.2%, 86.4% and 87.5%,respectively. Blood toxicity was the main early side effect with a 37.5% grade III-IV (RTOG), mild toxicities occurred in bladder (grade I/II 24.2%) and rectum (grade I/II 26.6%). Late side effects were found in 3 patients (2 radiocystitis, 1 intestinal obstruction). Conclusions: IMRT integrated adaptive 3D-HDR brachytherapy is a feasible way to boost the dosage of cervical lesions,preliminary clinical evaluation showed a better outcome and tolerable side effects.
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