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Effectiveness of intensity-modulated radiation therapy with simultaneous integrated boost in cervical cancer patients with PET positive lymph nodes

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Purpose

It is standard for our department to offer intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) for all node-positive cervical cancer patients. Multiple institutions have provided reports and here we provide our outcomes using IMRT [Vargo et al. (Int J Rad Oncol Biol Phys 90: 1091–1098, 9), Marnitz et al. (Strahlentherapie und Onkol 191: 421–428, 10), Jung et al. (Anticancer Res 34: 4361–4366, 11), Zhang et al. (J Gynecol Oncol 25: 14–21, 12), Ke et al. (Zhonghua Fu Chan Ke Za Zhi 48: 649–653, 13)] .

Methods and materials

Thirty-four patients with cervical cancer (stages IBI–IVB) diagnosed from 2013 to 2014 getting definitive chemoradiotherapy with positive pelvic and para-aortic nodes treated with IMRT and concurrent weekly cisplatin were retrospectively analyzed. IMRT was administered to the pelvis at 1.8 Gy/day to 45–50.4 Gy with SIB at 2.07 Gy/day to 51.75–57.96 Gy. Patients were then treated with brachytherapy with point A to 85–90 Gy followed by a nodal boost to bring positive nodes to 60–66 Gy. Full and empty bladder simulations were done to assess cervical motion. Daily cone beam CTs were utilized to assess for internal organ motion and weight changes.

Results

The nodal location was pelvis-only in 16 patients (47%) and pelvis + para-aortic in 16 patients (47%). With a median follow-up time of 26 months (range 4–47 months), 16 patients experienced recurrence or persistent disease. The sites of recurrent/persistent disease were cervix 10 (29%), regional nodes 6 (18%), and distant 10 (29%). Two-year overall survival was 73% and 2-year disease-free survival was 59%. Fourteen patients (41%) experienced grade 2 and 1 patient (3%) experienced grade 3 GI toxicity.

Conclusions

In patients with PET-positive nodes, IMRT is well tolerated and provides good local control and overall survival.

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Acknowledgements

The following research was presented on April 16 at the 2016 meeting of the American Radium Society.

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Authors and Affiliations

  1. Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    John W Shumway, Alfredo E Echeverria, Umang Patel, Joshua Asper, Mark Bonnen & Michelle Ludwig

  2. Division of Epidemiology, Human Genetics & Environmental Sciences, UT School of Public Health, Houston, TX, USA

    Michelle Ludwig

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  1. John W Shumway
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  2. Alfredo E Echeverria
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  3. Umang Patel
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  4. Joshua Asper
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Correspondence to Michelle Ludwig.

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No funding was required for this study.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional review board (IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was obtained for the retrospective chart review prior to beginning the study.

This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed consent

The IRB permitted waiving the informed consent since this is a retrospective patterns of care study.

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Shumway, J.W., Echeverria, A.E., Patel, U. et al. Effectiveness of intensity-modulated radiation therapy with simultaneous integrated boost in cervical cancer patients with PET positive lymph nodes. J Radiat Oncol 6, 167–173 (2017). https://doi.org/10.1007/s13566-017-0294-7

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  • DOI: https://doi.org/10.1007/s13566-017-0294-7

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