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Erschienen in:
10.02.2017 | Original Research
Effectiveness of intensity-modulated radiation therapy with simultaneous integrated boost in cervical cancer patients with PET positive lymph nodes
Erschienen in: Journal of Radiation Oncology | Ausgabe 2/2017
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Purpose
It is standard for our department to offer intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) for all node-positive cervical cancer patients. Multiple institutions have provided reports and here we provide our outcomes using IMRT [Vargo et al. (Int J Rad Oncol Biol Phys 90: 1091–1098, 9), Marnitz et al. (Strahlentherapie und Onkol 191: 421–428, 10), Jung et al. (Anticancer Res 34: 4361–4366, 11), Zhang et al. (J Gynecol Oncol 25: 14–21, 12), Ke et al. (Zhonghua Fu Chan Ke Za Zhi 48: 649–653, 13)] .
Methods and materials
Thirty-four patients with cervical cancer (stages IBI–IVB) diagnosed from 2013 to 2014 getting definitive chemoradiotherapy with positive pelvic and para-aortic nodes treated with IMRT and concurrent weekly cisplatin were retrospectively analyzed. IMRT was administered to the pelvis at 1.8 Gy/day to 45–50.4 Gy with SIB at 2.07 Gy/day to 51.75–57.96 Gy. Patients were then treated with brachytherapy with point A to 85–90 Gy followed by a nodal boost to bring positive nodes to 60–66 Gy. Full and empty bladder simulations were done to assess cervical motion. Daily cone beam CTs were utilized to assess for internal organ motion and weight changes.
Results
The nodal location was pelvis-only in 16 patients (47%) and pelvis + para-aortic in 16 patients (47%). With a median follow-up time of 26 months (range 4–47 months), 16 patients experienced recurrence or persistent disease. The sites of recurrent/persistent disease were cervix 10 (29%), regional nodes 6 (18%), and distant 10 (29%). Two-year overall survival was 73% and 2-year disease-free survival was 59%. Fourteen patients (41%) experienced grade 2 and 1 patient (3%) experienced grade 3 GI toxicity.
Conclusions
In patients with PET-positive nodes, IMRT is well tolerated and provides good local control and overall survival.