1Zhejiang Chinese Medical University, Hangzhou 310053, China; 2Department of Gynecologic Radiation Oncology, the Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China
AbstractObjective To compare the clinical efficacy and toxicity of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in radical radiotherapy for cervical cancer. Methods Clinical data of 1002 patients with cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed. All patients were divided into the IMRT group and 3D-CRT group according to the technology of external beam radiation therapy (EBRT). After 1∶1 propensity score matching (PSM), clinical prognosis of patients receiving IMRT or 3D-CRT was compared. Continuous data were expressed as Mean ± SD or median. Categorical data were described by case number (percentage). Quantitative data were compared by t-test. Qualitative data were compared by chi-square test or Fisher's exact test. Survival rates in two groups were calculated by Kaplan-Meier method and log-rank test. Results The percentage of patients who received pelvic and para-aortic radiotherapy in the IMRT group was significantly higher than that in the 3D-CRT group (14.9% vs. 1.2%, P<0.001). The percentage of patients whose positive lymph nodes dose reached 55 Gy or more in the IMRT group was significantly higher than that in the 3D-CRT group (26.6% vs. 15.5%, P=0.002). In the IMRT group, the 5-year disease-free survival (DFS) rate (74.6% vs. 68.9%, P=0.084) and overall survival (OS) rate (79.4% vs. 74.9%, P=0.270) were slightly higher than those in the 3D-CRT group, but there were no significant differences between two groups. In the IMRT group, the local recurrence (3.0% vs. 6.9%, P=0.020) and distant lymph node metastasis rates (4.2% vs. 9.0%, P=0.013) were significantly lower compared with those in the 3D-CRT group. In terms of acute radiotherapy toxicities, grade 3-4 leukopenia (46.3% vs. 37.9%, P=0.028) and anemia (18.8% vs. 14.0%, P<0.001) occurred significantly more frequently in the IMRT group than in the 3D-CRT group. Conclusions Both IMRT and 3D-CRT could achieve good therapeutic outcomes in radical radiotherapy of cervical cancer. IMRT can boost the radiation dose of metastatic lymph nodes and has significant advantages in reducing local recurrence and distant lymph node metastasis.
Fund:Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2018KY306, 2022KY647); Key Program of Medical Health Science and Major Technology Project of Zhejiang Provincial Health Commission (WKJ-ZJ-2020)
Rao Huiting,Feng Tao,Wu Chufan et al. The efficacy of intensity-modulated radiotherapy in radical radiotherapy for cervical cancer: a propensity score matching analysis[J]. Chinese Journal of Radiation Oncology, 2023, 32(5): 415-421.
Rao Huiting,Feng Tao,Wu Chufan et al. The efficacy of intensity-modulated radiotherapy in radical radiotherapy for cervical cancer: a propensity score matching analysis[J]. Chinese Journal of Radiation Oncology, 2023, 32(5): 415-421.
[1] Zheng R, Zhang S, Zeng H, et al.Cancer incidence and mortality in China, 2016[J]. J Nation Cancer Center, 2022, 2: 1-9. DOI: 10.1016/j.jncc.2022.02.002.
[2] Thomas RJ, Provenzano D, Goyal S, et al.Trends in guideline-adherent chemoradiation therapy for locally advanced cervical cancer before and after the affordable care act[J]. Gynecol Oncol, 2022,166(1):165-172. DOI: 10.1016/j.ygyno.2022.04.015.
[3] le Guyader M, Lam Cham Kee D, Thamphya B, et al. High-dose-rate brachytherapy boost for locally advanced cervical cancer: oncological outcome and toxicity analysis of 4 fractionation schemes[J]. Clin Transl Radiat Oncol, 2022,32:15-23. DOI: 10.1016/j.ctro.2021.10.005.
[4] Chopra S, Gupta S, Kannan S, et al.Late toxicity after adjuvant conventional radiation versus image-guided intensity-modulated radiotherapy for cervical cancer (PARCER): a randomized controlled trial[J]. J Clin Oncol, 2021,39(33):3682-3692. DOI: 10.1200/JCO.20.02530.
[5] Huang J, Gu F, Ji T, et al.Pelvic bone marrow sparing intensity modulated radiotherapy reduces the incidence of the hematologic toxicity of patients with cervical cancer receiving concurrent chemoradiotherapy: a single-center prospective randomized controlled trial[J]. Radiat Oncol, 2020,15(1):180. DOI: 10.1186/s13014-020-01606-3.
[6] Marjanovic D, Plesinac Karapandzic V, Stojanovic Rundic S, et al.Acute toxicity of postoperative intensity-modulated radiotherapy and three-dimensional conformal radiotherapy for cervical cancer: the role of concomitant chemotherapy[J]. J BUON, 2019,24(6):2347-2354.
[7] Mahantshetty U, Naga P, Nachankar A, et al.Set-up errors, organ motion, tumour regression and its implications on internal target volume-planning target volume during cervical cancer radiotherapy: results from a prospective study[J]. Clin Oncol (R Coll Radiol), 2022,34(3):189-197. DOI: 10.1016/j.clon.2021.10.010.
[8] Yu K, Zhou L.Intensity-modulated radiotherapy and three-dimensional conformal radiotherapy combined with intracavitary posterior radiotherapy for the treatment of medium-term and advanced cervical cancer: efficacy, safety and prognostic factors[J]. Front Surg, 2022,9:906117. DOI: 10.3389/fsurg.2022.906117.
[9] Guy JB, Falk AT, Auberdiac P, et al.Dosimetric study of volumetric arc modulation with RapidArc and intensity-modulated radiotherapy in patients with cervical cancer and comparison with 3-dimensional conformal technique for definitive radiotherapy in patients with cervical cancer[J]. Med Dosim, 2016,41(1):9-14. DOI: 10.1016/j.meddos.2015.06.002.
[10] Shewalkar B, Khan A, Yerlekar D, et al.Dose-escalated intensity-modulated radiotherapy for the management of locally advanced cervical cancer[J]. Cureus, 2022,14(6):e25965. DOI: 10.7759/cureus.25965.
[11] Chen SW, Liang JA, Hung YC, et al.Does initial 45Gy of pelvic intensity-modulated radiotherapy reduce late complications in patients with locally advanced cervical cancer? A cohort control study using definitive chemoradiotherapy with high-dose rate brachytherapy[J]. Radiol Oncol, 2013,47(2):176-184. DOI: 10.2478/raon-2013-0011.
[12] Cox JD, Stetz J, Pajak TF.Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)[J]. Int J Radiat Oncol Biol Phys, 1995,31(5):1341-1346. DOI: 10.1016/0360-3016(95)00060-C.
[13] Klopp AH, Yeung AR, Deshmukh S, et al.Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG oncology-RTOG 1203[J]. J Clin Oncol, 2018,36(24):2538-2544. DOI: 10.1200/JCO.2017.77.4273.
[14] Chang Y, Yang ZY, Li GL, et al.Correlations between radiation dose in bone marrow and hematological toxicity in patients with cervical cancer: a comparison of 3DCRT, IMRT, and RapidARC[J]. Int J Gynecol Cancer, 2016,26(4):770-776. DOI: 10.1097/IGC.0000000000000660.
[15] Yusufaly T, Miller A, Medina-Palomo A, et al.A multi-atlas approach for active bone marrow sparing radiation therapy: implementation in the NRG-GY006 Trial[J]. Int J Radiat Oncol Biol Phys, 2020,108(5):1240-1247. DOI: 10.1016/j.ijrobp.2020.06.071.
[16] Huang J, Gu F, Ji T, et al.Pelvic bone marrow sparing intensity modulated radiotherapy reduces the incidence of the hematologic toxicity of patients with cervical cancer receiving concurrent chemoradiotherapy: a single-center prospective randomized controlled trial[J]. Radiat Oncol, 2020,15(1):180. DOI: 10.1186/s13014-020-01606-3.
[17] 张宝忠, 刘志艳, 徐利明, 等. 宫颈癌三维放疗同步化疗不同解剖部位骨髓受量与中性粒细胞毒性关系[J].中华放射肿瘤学杂志,2020,29(9):767-771. DOI: 10.3760/cma.j.cn113030-20200325-00135.
Zhang BZ, Liu ZY, Xu LM, et al.Relationship between the radiation dose of different anatomic bony sites and neutrophil toxicity in three-dimensional radiotherapy concurrent chemotherapy for cervical cancer[J].Chin J Radiat Oncol,2020,29(9):767-771. DOI: 10.3760/cma.j.cn113030-20200325-00135.
[18] Bondar ML, Hoogeman MS, Mens JW, et al.Individualized nonadaptive and online-adaptive intensity-modulated radiotherapy treatment strategies for cervical cancer patients based on pretreatment acquired variable bladder filling computed tomography scans[J]. Int J Radiat Oncol Biol Phys, 2012,83(5):1617-1623. DOI: 10.1016/j.ijrobp.2011.10.011.
[19] 欧阳水根, 陶娜, 刘婷婷, 等. 分次间位置不确定性对宫颈癌调强放疗靶区结构累积剂量影响[J].中华放射肿瘤学杂志,2021,30(8):822-827. DOI: 10.3760/cma.j.cn113030-20200328-00138.
Ouyang SG, Tao N, Liu TT, et al.Effect of inter-fractional positional uncertainty on cumulative dose of target volume in intensity-modulated radiotherapy of cervical cancer[J]. Chin J Radiat Oncol,2021,30(8):822-827. DOI: 10.3760/cma.j.cn113030-20200328-00138.
[20] Yu C, Zhu W, Ji Y, et al.A comparative study of intensity-modulated radiotherapy and standard radiation field with concurrent chemotherapy for local advanced cervical cancer[J]. Eur J Gynaecol Oncol, 2015,36(3):278-282.
[21] Nomden CN, Pötter R, de Leeuw A, et al. Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: patterns of failure in the EMBRACE study cohort[J]. Radiother Oncol, 2019,134:185-190. DOI: 10.1016/j.radonc.2019.02.007.
2023, Vol. 32 
