ABSTRACT
PURPOSE: To evaluate disease outcomes and toxicity in cervical cancer patients treated with pelvic intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: We included all patients with Stage I-IVA cervical carcinoma treated with IMRT at three different institutions from 2000-2007. Patients treated with extended field or conventional techniques were excluded. Intensity-modulated radiation therapy plans were designed to deliver 45 Gy in 1.8-Gy daily fractions to the planning target volume while minimizing dose to the bowel, bladder, and rectum. Toxicity was graded according to the Radiation Therapy Oncology Group system. Overall survival and disease-free survival were estimated by use of the Kaplan-Meier method. Pelvic failure, distant failure, and late toxicity were estimated by use of cumulative incidence functions. RESULTS: The study included 111 patients. Of these, 22 were treated with postoperative IMRT, 8 with IMRT followed by intracavitary brachytherapy and adjuvant hysterectomy, and 81 with IMRT followed by planned intracavitary brachytherapy. Of the patients, 63 had Stage I-IIA disease and 48 had Stage IIB-IVA disease. The median follow-up time was 27 months. The 3-year overall survival rate and the disease-free survival rate were 78% (95% confidence interval [CI], 68-88%) and 69% (95% CI, 59-81%), respectively. The 3-year pelvic failure rate and the distant failure rate were 14% (95% CI, 6-22%) and 17% (95% CI, 8-25%), respectively. Estimates of acute and late Grade 3 toxicity or higher were 2% (95% CI, 0-7%) and 7% (95% CI, 2-13%), respectively. CONCLUSIONS: Intensity-modulated radiation therapy is associated with low toxicity and favorable outcomes, supporting its safety and efficacy for cervical cancer. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT vs. conventional techniques.
Subject(s)
Radiotherapy, Intensity-Modulated/methods , Uterine Cervical Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Brachytherapy , Carboplatin/administration & dosage , Cisplatin/administration & dosage , Confidence Intervals , Female , Fluorouracil/administration & dosage , Follow-Up Studies , Humans , Hysterectomy/methods , Middle Aged , Neoplasm Staging/methods , Radiation Dosage , Radiotherapy, Intensity-Modulated/adverse effects , Rectum/radiation effects , Survival Rate , Treatment Outcome , Urinary Bladder/radiation effects , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/pathology , Vinblastine/administration & dosage , Vinblastine/analogs & derivatives , VinorelbineABSTRACT
PURPOSE: To identify dosimetric parameters associated with acute hematologic toxicity (HT) and chemotherapy delivery in cervical cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. METHODS AND MATERIALS: We analyzed 37 cervical cancer patients receiving concurrent cisplatin (40 mg/m(2)/wk) and intensity-modulated pelvic radiotherapy. Pelvic bone marrow (BM) was contoured for each patient and divided into three subsites: lumbosacral spine, ilium, and lower pelvis. The volume of each region receiving 10, 20, 30, and > or =40 Gy (V(10), V(20), V(30), and V(40), respectively) was calculated. HT was graded according to the Radiation Therapy Oncology Group system. Multivariate regression models were used to test associations between dosimetric parameters and HT and chemotherapy delivery. RESULTS: Increased pelvic BM V(10) (BM-V(10)) was associated with an increased Grade 2 or worse leukopenia and neutropenia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.24-3.53; p = 0.006; and OR, 1.41; 95% CI, 1.02-1.94; p = 0.037, respectively). Patients with BM-V(10) > or =90% had higher rates of Grade 2 or worse leukopenia and neutropenia than did patients with BM-V(10) <90% (11.1% vs. 73.7%, p < 0.01; and 5.6% vs. 31.6%, p = 0.09) and were more likely to have chemotherapy held on univariate (16.7% vs. 47.4%, p = 0.08) and multivariate (OR, 32.2; 95% CI, 1.67-622; p = 0.02) analysis. No associations between HT and V(30) and V(40) were observed. Dosimetric parameters involving the lumbosacral spine and lower pelvis had stronger associations with HT than did those involving the ilium. CONCLUSION: The volume of pelvic BM receiving low-dose radiation is associated with HT and chemotherapy delivery in cervical cancer patients undergoing concurrent chemoradiotherapy.
Subject(s)
Bone Marrow/radiation effects , Hematologic Diseases/etiology , Radiotherapy, Intensity-Modulated/adverse effects , Uterine Cervical Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Analysis of Variance , Anemia/blood , Anemia/etiology , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Bone Marrow/drug effects , Cisplatin/administration & dosage , Cisplatin/therapeutic use , Combined Modality Therapy/methods , Female , Femur Head/radiation effects , Hematologic Diseases/blood , Humans , Ilium/radiation effects , Leukopenia/blood , Leukopenia/etiology , Lumbosacral Region/radiation effects , Middle Aged , Neutropenia/blood , Neutropenia/etiology , Radiation-Sensitizing Agents/administration & dosage , Radiation-Sensitizing Agents/therapeutic use , Radiotherapy Dosage , Sacrum/radiation effects , Thrombocytopenia/blood , Thrombocytopenia/etiology , Uterine Cervical Neoplasms/blood , Uterine Cervical Neoplasms/drug therapyABSTRACT
Radiation therapy is used as either definitive or adjuvant therapy following surgery in many gynecologic malignancies. Though effective, radiation therapy is limited by the adverse sequelae that result from normal tissues receiving external-beam radiation. A novel approach, intensity-modulated radiation therapy, can overcome these limitations by sparing the tissue surrounding the malignancy through conforming the dose to the shape of the target in three dimensions. This review provides an overview of current use, published research, and ongoing studies of intensity-modulated radiation therapy.
