J Gynecol Oncol.  2014 Jan;25(1):14-21. 10.3802/jgo.2014.25.1.14.

Definitive extended field intensity-modulated radiotherapy and concurrent cisplatin chemosensitization in the treatment of IB2-IIIB cervical cancer

• Zhang G
• He F
• Fu C
• Zhang Y
• Yang Q
• Wang J
• Cheng Y

• KMID: 1811183
• DOI: http://doi.org/10.3802/jgo.2014.25.1.14

Abstract

OBJECTIVE
To assess the toxicity of delivering extended field intensity-modulated radiotherapy (EF-IMRT) and concurrent cisplatin chemotherapy for locally advanced cervical carcinoma.
METHODS
Forty-five patients who underwent EF-IMRT and concurrent cisplatin chemotherapy for the treatment of stage IB2 to IIIB cervical cancer were retrospectively reviewed. The clinical target volume included all areas of gross and potentially microscopic disease and regional lymph node regions. All patients underwent high-dose-rate brachytherapy. The acute and late toxicity were scored using the Common Terminology Criteria for Adverse Events and the Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively.
RESULTS
The median follow-up was 28 months (range, 5 to 62 months). Forty-two patients had a complete response, and three had a persistent disease. Of those 42 patients, 15 patients (35.7%) had recurrence. The regions of recurrence were in-field in 2 patients and out-field in 13 patients. Acute grade > or =3 gastrointestinal, genitourinary and hematologic toxicity occurred in 3, 1, and 9 patients, respectively. Three patients (6.7%) suffered from late grade 3 toxicities. Seven patients experienced ovarian transposition, 5 of those patients (71%) maintained ovarian function. Thirty-eight patients (84.4%) were alive at the last follow-up.
CONCLUSION
Concurrent cisplatin chemotherapy with EF-IMRT was safe. The acute and late toxicities are acceptable. EF-IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.

Keyword

Cervical cancer; Chemotherapy; Extended field; Intensity-modulated radiotherapy; Toxicity

MeSH Terms

Brachytherapy
Cisplatin*
Drug Therapy
Follow-Up Studies
Humans
Lymph Nodes
Radiotherapy, Intensity-Modulated*
Recurrence
Retrospective Studies
Uterine Cervical Neoplasms*
Cisplatin

Figure

• 

  Fig. 1 The transverse image of the target volume. (A-C) showing primary tumor and pelvic lymph nodes planning target volume (PTV) depicted in red color wash and PTV was covered by 50.4 Gy (green line). The involved para-aortic lymph nodal PTV is depicted in blue color wash. (D) Showing left transposed ovarian covered by orange color wash and right covered by purple color wash (V7≤50%). (E) Sagittal and (F) coronal image showing PTV (red color wash) covered by 100% isodose line (green line, 50.4 Gy).

• 

  Fig. 2 The dose-volume histogram of the extended field intensity-modulated radiotherapy plan. The rectum and the bladder, V45≤50%, respectively; the small intestine, V35≤45%; the kidney received, V25≤33%; the liver, V30≤30%; the bone marrow, V10≤90% and V35≤45%; the ovarian, V7≤50%; the spinal cord, V40≤0.1 cubic centimeters.

• 

  Fig. 3 (A) Kaplan-Meier graph showing disease-free survival. (B) Kaplan-Meier graph showing overall survival.

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