Vaginal Dose and Patient Reported Sexual Adjustment With MR-Guided Brachytherapy for Cervical Cancer

Abstract

Purpose/Objective(s): To assess the efficacy of simultaneous integrated or late course accelerated boost with EBRT to vaginal stump in intermediate risk cervical cancer patients after radical hysterectomy. Materials/Methods: Between October 2009 and January 2012, patients with intermediate risk cervical cancer who had undergone radical surgery for stage IB-IIB were enrolled in this study. Patients were delivered either simultaneous integrated boost intensive modulated radiotherapy (IMRT) / volumetric modulated arc therapy (VMAT) (arm-A) or late course accelerated boost with three dimensionalconformal radiotherapy (3D-CRT) after IMRT/VMAT to the pelvic (arm-B). Chemotherapy with paclitaxel + cisplatin (TP) or 5-Fu + cisplatin (FP) were given concomitantly. The clinical target volume 1 (CTV1) was delineated according to the consensus guidelines of CTV in postoperative treatment of endometrial and cervical cancer. The vaginal dump was delineated to be CTV2. The planning target volume, PTV1 and PTV2 were created by extending the CTV1 and CTV2, respectively, using a margin of 10 mm in the axial plane except in the front of the rectal, where the margin is 5 mm. All the plans were performed in the pinnacle treatment plan system (TPS). In arm-A, 50.4Gy/28f and 60.2Gy/28f were delivered to PTV1 and PTV2, respectively, with simultaneous integrated boost IMRT/VMAT technique. In arm-B, a dose of 50Gy/25f was delivered to the PTV1 with IMRT/VMAT technique; and then, 9Gy/3f was boosted to PTV2 with 3D-CRT. Progress-free survival (PFS), the rate of local-regional failure and distance recurrence were compared between two arms. Results: Overall, 80 patients were enrolled in this study (42 in arm-A, 38 in arm-B). Median follow-up was 37 months (15-49m) in arm A and 32 months (16-47m) in arm B. 3year PFS rates was 90.5% in arm-A and 92.1% in arm-B (pZ 0.78). 3 year rate of local-regional failure and distant metastasis were 2.38% vs. 0%, and 7.14% vs. 7.89%, respectively. Conclusions: Both simultaneous integrated boost IMRT/VMAT and late course accelerated boost with EBRT after IMRT/VMAT to the pelvic are feasible and effective to the intermediate risk cervical cancer patients after radical hysterectomy. Author Disclosure: X. Wang: None. Y. Shen: None. Y. Zhao: None. Z. Li: None. S. Bai: None. F. Xu: None.