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. 2019 Dec;11(6):516-526.
doi: 10.5114/jcb.2019.90478. Epub 2019 Dec 8.

High precision radiotherapy including intensity-modulated radiation therapy and pulsed-dose-rate brachytherapy for cervical cancer: a retrospective monoinstitutional study

Andrea Vavassori  1 , Giulia Riva  1   2 , Ruggero Spoto  1 , Roberta Lazzari  1 , Cristiana Fodor  1 , Samantha Dicuonzo  1 , Claudia Maria Francia  1   2 , Matteo Augugliaro  1   2 , Giuseppe Facondo  1   3 , Raffaella Cambria  4 , Stefania Comi  4 , Federica Cattani  4 , Francesca Botta  5 , Vincenzo Bagnardi  5 , Stefania Rizzo  6 , Nicoletta Colombo  7   8 , Roberto Orecchia  9 , Barbara Alicja Jereczek-Fossa  1   2
Affiliations

High precision radiotherapy including intensity-modulated radiation therapy and pulsed-dose-rate brachytherapy for cervical cancer: a retrospective monoinstitutional study

Andrea Vavassori et al. J Contemp Brachytherapy. 2019 Dec.

Abstract

Purpose: To analyse the survival outcomes and toxicity profile of patients treated with pulsed-dose-rate (PDR) brachytherapy (BT) after intensity-modulated radiation therapy (IMRT) for uterine cervical cancer in a single institution.

Material and methods: Between March 2011 and December 2014, 50 patients with histologically proven stages IB1-IVB cervical cancer were treated with IMRT followed by PDR-BT boost. Radiation treatment consisted of IMRT to pelvic with or without paraaortic lymph nodes to a total dose of 45-50.4 Gy. Weekly concomitant chemotherapy was administered to 45 patients. PDR-BT boost was delivered with a median dose of 30 Gy to the high-risk clinical target volume (HR-CTV) after a median time of 14 days since IMRT. Acute and late toxicity were evaluated by Radiation Therapy Oncology Group (RTOG) - European Organization for Research and Treatment of Cancer (EORTC) scoring criteria and Subjective Objective Management Analytic-Late Effects of Normal Tissues (SOMA-LENT) criteria.

Results: Two patients had tumour persistence at 6 months after the end of BT. After a median follow-up of 33 months, 6 distant metastases with or without regional relapse were observed. The 1- and 5-year progression-free survival was 83% (95% CI: 69-91%) and 76% (95% CI: 61-86%), whereas the 3- and 5-year overall survival was 91% (95% CI: 78-97%) and 76% (95% CI: 56-88%), respectively. Urinary and rectal toxicity higher than grade 2 was observed in 6.3% and 17% of patients, respectively. Five patients (10.6%) had grade 4 gastrointestinal toxicity requiring colostomy.

Conclusions: Our study confirms that the combination of IMRT and PDR-BT can be considered an effective treatment for cervical cancer, ensuring high local control, despite the high percentage of locally advanced disease.

Keywords: IMRT; PDR; brachytherapy; cervical cancer.

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Figures

Fig. 1
Fig. 1
Flowchart of patients enrolled in the study
Fig. 2
Fig. 2
Progression-free survival for all stages
Fig. 3
Fig. 3
Progression-free survival for I/II vs. III/IV FIGO stage
Fig. 4
Fig. 4
Overall survival for all stages
Fig. 5
Fig. 5
Overall survival for I/II vs. III/IV FIGO stage
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