Current Treatment Options in Oncology

, Volume 5, Issue 2, pp 97–108 | Cite as

Intensity-modulated radiation therapy in gynecologic malignancies

  • Joseph K. Salama
  • John C. Roeske
  • Neil Mehta
  • Arno J. Mundt
Article

Opinion statement

Radiation therapy occupies an important role in the treatment of gynecologic malignancies. Unfortunately, traditional approaches result in the irradiation of large volumes of normal tissues exposing patients to many toxicities and precluding dose escalation in select patients. A novel approach to the planning and delivery of radiation therapy, known as intensity-modulated radiation therapy (IMRT), has been introduced. Unlike conventional approaches, IMRT conforms the prescription dose to the shape of the target in three dimensions, thus sparing the surrounding normal tissues. Multiple studies have demonstrated the clear superiority of IMRT planning in these patients in terms of normal tissue sparing. Promising clinical results have also been published, suggesting that IMRT reduces the incidence of acute and chronic toxicity in these women. Ongoing studies are focusing on tumor control and patient outcome. Although further work is needed, these results suggest that IMRT may represent a major advancement in the planning and delivery of radiation therapy in patients with gynecologic malignancies.

Keywords

Cervical Cancer Planning Target Volume Radiat Oncol Biol Phys Clinical Target Volume Gynecologic Malignancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References and Recommended Reading

  1. 1.
    Cleaves M: Radium: with a preliminary note on radium rays in the treatment of cancer. Med Rec 1903, 64:1719–1723.Google Scholar
  2. 2.
    Corn BW, Lanciano RM, Greven KM, et al.: Impact of improved irradiation technique, age, and lymph node sampling on the severe complication rate of surgically staged endometrial cancer patients: a multivariate analysis. J Clin Oncol 1994, 12:510–515.PubMedGoogle Scholar
  3. 3.
    Perez CA, Breaux S, Bedwinek JM, et al.: Radiation therapy alone in the treatment of carcinoma of the uterine cervix II: analysis of complications. Cancer 1984, 54:235–246.PubMedCrossRefGoogle Scholar
  4. 4.
    Snijders-Keiholz A, Griffioen G, Davelaar J, et al.: Vitamin B12 malabsorption after irradiation for gynaecological tumours. Anticancer Res 1993, 13:1877–1881.Google Scholar
  5. 5.
    Creutzberg CL, van Putten WL, Koper PC, et al.: Surgery and postoperative radiotherapy versus surgery alone for patients with stage I endometrial carcinoma: multicentre randomized trial. Lancet 2000, 355:1404–1411.PubMedCrossRefGoogle Scholar
  6. 6.
    Keys HM, Bundy BN, Stehman FB, et al.: Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999, 340:1154–1161.PubMedCrossRefGoogle Scholar
  7. 7.
    Lhomme C, Fumoleau P, Fargeot P, et al.: Results of the European Organization for Research and Treatment of Cancer/Early Clinical Studies Group phase II trial of first-line irinotecan in patients with advanced or recurrent squamous cell carcinoma of the cervix. J Clin Oncol 1999, 17:3136–3142.PubMedGoogle Scholar
  8. 8.
    Rose PG, Cha SD, Tak WK, et al.: Radiation therapy for surgically proven para-aortic node metastases in endometrial carcinoma. Int J Radiat Oncol Biol Phys 1992, 24:229–235.PubMedGoogle Scholar
  9. 9.
    Gibbons S, Martinez A, Schray M, et al.: Adjuvant whole abdomino-pelvic irradiation for high-risk endometrial carcinoma. Int J Radiat Oncol Biol Phys 1991, 21:1019–1024.PubMedGoogle Scholar
  10. 10.
    Ferreira PR, Braga-Filho A, Barletta A, et al.: Radiation therapy alone in stage III-B cancer of the uterine cervix: a 17-year-old experience in south Brazil. Int J Radiat Oncol Biol Phys 1999, 45:441–446.PubMedCrossRefGoogle Scholar
  11. 11.
    Stock RG, Chen AS, Flickinger JC, et al.: Node-positive cervical cancer: impact of pelvic irradiation and patterns of failure. Int J Radiat Oncol Biol Phys 1995, 31:31–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Leibel SA, Fuks Z, Zelefsky MJ, et al.: Intensity-modulated radiotherapy. Cancer J 2002, 8:164–175. A comprehensive review of the physics and clinical applications of IMRT in a wide number of disease sites.PubMedCrossRefGoogle Scholar
  13. 13.
    Nutting C, Dearnaley DP, Webb S: Intensity-modulated radiation therapy: a clinical review. Br J Radiol 2000, 73:459–465.PubMedGoogle Scholar
  14. 14.
    Takahashi S: Conformationradiotherapy: rotation techniques as applied to radiography and radiotherapy of cancer. Acta Radiol Diagn (Stockh) 1965, 242–261.Google Scholar
  15. 15.
    Brahme A: Optimization of stationary and moving beam radiation therapy technique. Radiother Oncol 1988, 12:129–134.PubMedCrossRefGoogle Scholar
  16. 16.
    Mell LK, Roeske JC, Mundt AJ: Survey of intensitymodulated radiotherapy use in the United States. Cancer 2003, 98:204–211. An important study detailing the current level of IMRT use in the United States.PubMedCrossRefGoogle Scholar
  17. 17.
    Zelefsky MJ, Fuks Z, Hunt M, et al.: High-dose intensitymodulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002, 53:1111–1118.PubMedCrossRefGoogle Scholar
  18. 18.
    Eisbruch A, Ship JA, Dawson LA: Salivary gland sparing and improved target irradiation by conformal and intensity-modulated irradiation of head and neck cancer. World J Surg 2003, 27:832–837.PubMedCrossRefGoogle Scholar
  19. 19.
    Chao KS, Ozyigit G, Tran BN, et al.: Patterns of failure in patients receiving definitive and postoperative IMRT for head and neck cancer. Int J Radiat Oncol Biol Phys 2003, 55:312–318.PubMedCrossRefGoogle Scholar
  20. 20.
    Roeske JC, Lujan A, Rotmensch J, et al.: Intensitymodulated whole pelvis radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2000, 48:1613–1621. The first published comparison of conventional and IMRT planning in patients with gynecologic malignancies, demonstrating the advantages of normal tissue sparing.PubMedCrossRefGoogle Scholar
  21. 21.
    Selvaraj RN, Gerszten K, King GC, et al.: Conventional 3-D versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative study of dose-volume histograms and the potential impact on toxicities [abstract]. Int J Radiat Oncol Biol Phys 2001, 51:218.CrossRefGoogle Scholar
  22. 22.
    Chen Q, Izadifar N, King S, et al.: Comparison of IMRT with 3-D CRT for gynecologic malignancies [abstract]. Int J Radiat Oncol Biol Phys 2001,51:332.CrossRefGoogle Scholar
  23. 23.
    Ahamad A, D’Souza W, Salehpour M, et al.: Intensitymodulated radiation therapy (IMRT) for post-hysterectomy pelvic radiation: selection of patients and planning target volume (PTV) [abstract]. Int J Radiat Oncol Biol Phys 2002, 54:42.CrossRefGoogle Scholar
  24. 24.
    Lujan AE, Mundt AJ, Yamada D, et al.: Intensitymodulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2003, 57:516–521. The first study illustrating the ability of IMRT to spare pelvic bone marrow in patients undergoing pelvic radiotherapy.PubMedCrossRefGoogle Scholar
  25. 25.
    Portelance L, Chao KS, Grigsby PW, et al.: Intensitymodulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 2001, 51:261–266.PubMedCrossRefGoogle Scholar
  26. 26.
    Hong L, Alektiar K, Chui C, et al.: IMRT of large fields: whole abdomen irradiation. Int J Radiat Oncol Biol Phys 2002, 54:278–289.PubMedCrossRefGoogle Scholar
  27. 27.
    Garofalo M, Lujan AE, Roeske JC, et al.: Intensity-modulated radiation therapy in the treatment of vulvar carcinoma. Paper presented at the 88th Annual Meeting of the Radiologic Society of North America. Chicago, IL, 2002.Google Scholar
  28. 28.
    Gilroy JS, Amdur RJ, Louis DA, et al.: Irradiating the inguinal nodes without breaking a leg [abstract]. Int J Radiat Oncol Biol Phys 2002, 54:68.CrossRefGoogle Scholar
  29. 29.
    Mohan R, Wu Q, Manning M, et al.: Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. Int J Radiat Oncol Biol Phys 2000, 46:619–630.PubMedCrossRefGoogle Scholar
  30. 30.
    Lujan AE, Mundt AJ, Roeske JC: Sequential versus simultaneous boost in the female pelvis using intensitymodulated radiation therapy. Paper presented at the 43rd Annual Meeting of the American Association of Physicists in Medicine. Salt Lake City, UT, 2001.Google Scholar
  31. 31.
    Mutic S, Malyapa RS, Grigsby PW, et al.: PET-guided IMRT for cervical carcinoma with positive para-aortic lymph nodes: a dose escalation treatment planning study. Int J Radiat Oncol Biol Phys 2003, 55:28–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Kavanagh B, Schefter TE, Wu Q, et al.: Clinical application of intensity-modulated radiotherapy for locally advanced cervical cancer. Semin Radiat Oncol 2002, 12:260–271.PubMedCrossRefGoogle Scholar
  33. 33.
    Mundt AJ, Roeske JC: Could intensity-modulated radiation therapy (IMRT) replace brachytherapy in the treatment of cervical cancer? Brachyther J 2002, 1:195–196.CrossRefGoogle Scholar
  34. 34.
    Alektiar K: Could intensity-modulated radiation therapy (IMRT) replace brachytherapy in the treatment of cervical cancer? Brachyther J 2002, 1:194–195.Google Scholar
  35. 35.
    Roeske JC, Mundt AJ: A feasibility study of IMRT for the treatment of cervical cancer patients unable to receive intracavitary brachytherapy. Med Phys 2000, 27:1382.Google Scholar
  36. 36.
    Low DA, Grigsby PW, Dempsey JF, et al.: Applicatorguided intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys 2002, 52:1400–1406.PubMedCrossRefGoogle Scholar
  37. 37.
    Schefter TE, Kavanagh BD, Wu Q, et al.: Technical considerations in the application of intensity-modulated radiotherapy as a concomitant integrated boost for locally advanced cervix cancer. Med Dosim 2002, 27:177–184.PubMedCrossRefGoogle Scholar
  38. 38.
    Mundt AJ, Roeske JC, Lujan AE, et al.: Initial clinical experience with intensity modulated whole pelvis radiation therapy in women with gynecologic malignancies. Gynecol Oncol 2001, 82:456–463.PubMedCrossRefGoogle Scholar
  39. 39.
    Mundt AJ, Lujan AE, Rotmensch J, et al.: Intensitymodulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2002, 52:1330–1337. An important study detailing the reduction in acute gastrointestinal toxicity achieved using IMRT planning in patients with gynecologic malignancies.PubMedCrossRefGoogle Scholar
  40. 40.
    Brixey CJ, Roeske JC, Lujan AE, et al.: Impact of intensitymodulated radiation therapy on acute hematologic toxicity in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2002, 54:1388–1396.PubMedCrossRefGoogle Scholar
  41. 41.
    Roeske JC, Bonta D, Lujan AE, et al.: Dose volume histogram analysis of acute gastrointestinal toxicity in gynecologic patients undergoing intensity-modulated whole pelvic radiation therapy. Radiother Oncol 2003, in press.Google Scholar
  42. 42.
    Mundt AJ, Mell LK, Roeske JC: Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2003, 56:1354–1360.PubMedCrossRefGoogle Scholar
  43. 43.
    Mundt AJ, Roeske JC, Lujan JC: IMRT in gynecologic malignancies. Med Dosim 2002, 27:131–136. A comprehensive review of the IMRT process in patients with gynecologic malignancies.PubMedCrossRefGoogle Scholar
  44. 44.
    Adli M, Mayr NA, Kaiser HS, et al.: Does prone positioning reduce bowel dose in pelvic radiation with intensitymodulated radiation therapy (IMRT) for gynecologic cancer. Int J Radiat Oncol Biol Phys 2003, 57:230–238.PubMedCrossRefGoogle Scholar
  45. 45.
    Hall E, Wuu CS: Radiation-induced second cancer: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003, 56:83–88. An important study highlighting concerns regarding the potential increased risk of second malignancies in patients treated with IMRT.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Joseph K. Salama
  • John C. Roeske
  • Neil Mehta
  • Arno J. Mundt
    • 1
  1. 1.Department of Radiation and Cellular OncologyUniversity of ChicagoChicagoUSA

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