Clinical efficacy of HDR brachytherapy with concomitant complementary IMRT boost for bulky uterine cervical cancer
Lu Shun, Fan Zixuan, Sun Chang, Tan Mingyu, Zhang Hanyi, Feng Mei, Yin Jun, Yin Gang, Li Jie, Lang Jinyi
Department of Radiotherapy,Sichuan Cancer Center/Sichuan Cancer Hospital& Institute,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,China
Abstract：Objective To investigate the clinical outcomes of patients with locally advanced uterine cervical cancer (UCC) treated by 3-dimensional high dose rate-intracavitary brachytherapy (3D HDR-ICBT) combined with complementary applicator-guided external beam radiotherapy (EBRT). Methods A total of 120 patients pathologically diagnosed with locally advanced UCC (tumors with a maximum diameter≥6 cm or≥5 cm complicated with eccentric tumor growth) treated with concurrent chemoradiotherapy (CCRT) from June 2010 to June 2015 were recruited. Five fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were performed. The prescribed dose for HR-CTV and IR-CTV was 7 Gy(D90) and 5-6 Gy(D90). The rectum, sigmoid colon, bladder and adjacent small intestine were delineated as the organs at risk. Intensity-modulated radiation therapy (IMRT) was used for EBRT (45 Gy/25f) combined with cisplatin-based chemotherapy every three weeks (75 mg/m2). Results The median follow-up time was 46 months (14-96 months). The 5-year local control rate (LCR),disease-free survival (DFS),and overall survival (OS) were 92.8%,76.6% and 81.0%,respectively. The incidence rate of grade I-Ⅱ genitourinary and gastrointestinal acute toxicities were 57.8% and 14.6%, whereas 8.1% and 2.9% for grade Ⅲ toxicities. The incidence rate of later grade Ⅰ-Ⅱ genitourinary and gastrointestinal toxicities were 8.4% and 5.3%, and 0.97% and 1.3% for grade Ⅲ late toxicities. Conclusions The combination of HDR-ICBT with an applicator-guided IMRT (ICBT+IMRT) yields low incidence of severe adverse events, relatively high LC and OS rate for locally advanced UCC. It is an efficacious comprehensive treatment of locally advanced bulky UCC.
Lu Shun,Fan Zixuan,Sun Chang et al. Clinical efficacy of HDR brachytherapy with concomitant complementary IMRT boost for bulky uterine cervical cancer[J]. Chinese Journal of Radiation Oncology, 2019, 28(7): 522-526.
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