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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2019
vol. 11
 
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abstract:
Original paper

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

1.
Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
2.
Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
3.
University of Milan, Milan, Italy
4.
Unit of Medical Physics, IEO European Institute of Oncology IRCCS, Milan, Italy
5.
Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
6.
Department of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
7.
University of Milan-Bicocca, Milan, Italy
8.
IEO European Institute of Oncology IRCCS, Milan, Italy
9.
Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
J Contemp Brachytherapy 2019; 11, 6: 516–526
DOI: https://doi.org/10.5114/jcb.2019.90478
Online publish date: 2019/12/08
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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:

cervical cancer, IMRT, brachytherapy, PDR

  
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