SBRT of gynecological cancer
Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer

https://doi.org/10.1016/j.radonc.2009.12.004Get rights and content

Abstract

Purpose

To evaluate outcome of radiotherapy for locally recurrent cervical and endometrial cancer.

Materials and methods

Nineteen patients were treated for a locally recurrent cervical (n = 12) or endometrial (n = 7) cancer median 26 months after initial surgery (n = 18) or radiotherapy (n = 1). The whole pelvis was irradiated with 50 Gy conventionally fractionated radiotherapy (n = 16). Because of large size of the recurrent cancer (median 4.5 cm) and peripheral location (n = 12), stereotactic body radiotherapy (SBRT; median 3 fractions of 5 Gy to 65%) was used for local dose escalation instead of (n = 16) or combined with (n = 3) vaginal brachytherapy.

Results

After median follow-up of 22 months, 3-year overall survival was 34% with systemic progression the leading cause of death (7/10). Median time to systemic progression was 16 months. Three local recurrences resulted in a local control rate of 81% at 3 years. No correlation between survival, systemic or local control and any patient or treatment characteristic was observed. The rate of late toxicity > grade II was 25% at 3 years: two patients developed a grade IV intestino-vaginal fistula and one patient suffered from a grade IV small bowel ileus.

Conclusion

Image-guided SBRT for local dose escalation resulted in high rates of local control but was associated with significant late toxicity.

Section snippets

Material and methods

Between 1997 and 2007, 19 patients have been treated with radiotherapy for an isolated pelvic tumor recurrence of cervical cancer (n = 12) or endometrial cancer (n = 7). A summary of the patient and treatment characteristics is shown in Table 1. Patients had been treated surgically at primary diagnosis of cancer (n = 18) and six of these patients had received adjuvant radiotherapy (vaginal brachytherapy only n = 4; combined external beam radiotherapy [EBRT] and vaginal brachytherapy n = 1; EBRT n = 1).

Results

Median EQD2 to the recurrent tumor was 68.8 Gy (range 40–75 Gy) considering the conventionally fractionated series and the dose at the PTV margin of the SBRT boost. If the dose in the isocenter of the SBRT boost is considered as treatment dose, median EQD2 to the recurrent tumor was 82.8 Gy (range 62.2–93.8 Gy). Due to steep dose gradients at the PTV margin, the dose at the isocenter is usually a better estimate of the dose actually delivered to the CTV (Fig. 1). Note that vaginal brachytherapy was

Discussion

Pelvic recurrences after primary surgical treatment of gynaecological cancers are solitary without synchronous systemic progression in about 50% of patients [31]. Radiotherapy treatment is potentially curable in these patients and several prognostic factors have been identified.

Recurrent cancer extending to the pelvic wall is a significant negative prognostic factor for survival. The largest study by Jain et al. reported 5-year overall survival rates of 42% and 20% after radiotherapy for

Conclusions

SBRT for local dose escalation to the residual tumor after conventionally fractionated radiotherapy of the whole pelvis results in high rates of local control in an unfavourable patient collective, where large size of the recurrent tumor and/or location at the pelvic wall makes vaginal brachytherapy alone inappropriate for boost irradiation. The favourable outcome in terms of local control was associated with a 25% rate of late toxicity > grade II and survival was limited due to metastatic

References (33)

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