Abstract
BackgroundStereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied.Case PresentationA 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up.ConclusionsCCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.
Highlights
Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors
Concurrent chemoradiation therapy (CCRT) followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer
We report on a patient with locally advanced cervical cancer that was treated with HT-guided SBRT rather than brachytherapy because the presence of an unusual anatomic configuration of the uterus was a contraindication to the use of brachytherapy
Summary
It has been demonstrated that concurrent chemoradiation therapy (CCRT) followed by intracavity radiation is effective in the treatment of advanced cervical cancer [1]. Studies have shown that stereotactic body radiation therapy (SBRT), when using image-guided IMRT capable of delivering high doses of radiation in hypo-fractions, such as the HT system, is an effective and well-tolerated treatment for local control of tumors metastatic to the liver and lung [7,8]. Because of the presence of multiple uterine myomas with bleeding tendency, the SBRT technique with 24 Gy delivered to primary tumor part with 0.7 cm margin as PTV in 6 fractions over one week was used in place of brachytherapy after receiving approval from the institutional ethics committee of the Far Eastern Memorial Hospital. Follow-up MRI taken one month after completion of treatment showed no evidence of tumor recurrence (Figure 3). There was no evidence of fistula formation, local recurrence, or distant metastasis
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