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Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer

Toxicity, tumour response and outcome

Intensitätsmodulierte Rotationstherapie mit Cisplatin als neoadjuvante Behandlung beim primären, inoperablen Zervixkarzinom

Toxizität, Tumoransprechen und Behandlungsergebnis

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Abstract

Purpose

The goal of this work was to evaluate the feasibility and outcome of intensity-modulated arc therapy ± cisplatin (IMAT ± C) followed by hysterectomy for locally advanced cervical cancer.

Patients and methods

A total of 30 patients were included in the study. The primary tumour and PET-positive lymph node(s) received a simultaneous integrated boost. Four weeks after IMAT ± C treatment, response was evaluated. Resection consisted of hysterectomy with or without lymphadenectomy. Tumour response, acute and late radiation toxicity, postoperative morbidity and outcome were evaluated.

Results

All hysterectomy specimens were macroscopically tumour-free with negative resection margins; pathological complete response was 40%. In 2 patients, one resected lymph node was positive. There was no excess in postoperative morbidity. Apart from two grade 3 hematologic toxicities, no grade 3 or 4 acute radiation toxicity was observed. No grade 3, 1 grade 4 (4%) intestinal, and 4 grade 3 (14%) urinary late toxicities were observed. The 2-year local and regional control rates were 96% and 100%, respectively. The 2-year distant control rate was 92%. Actuarial 2-year progression free survival rate was 89%. Actuarial 1- and 2-year overall survival rates were 96% and 91%, while 3-year overall survival was 84%.

Conclusion

Surgery after IMAT ± C is feasible with low postoperative morbidity and radiation toxicity. Local, regional, distant control and survival rates are promising.

Zusammenfassung

Ziel

Endpunktergebnisse und Machbarkeitsbewertung einer intensitätsmodulierten Rotationstherapie mit oder ohne Cisplatin (IMAT ± C) vor der operativen Entfernung der Gebärmutter beim lokal fortgeschrittenen Zervixkarzinom.

Patienten und Methodik

Es nahmen 30 Patienten an der Studie teil (Tab. 1). Der Primärtumor und die PET-positiven Lymphknoten erhielten simultan einen integrierten Boost. Vier Wochen nach der kombinierten IMAT ± C-Behandlung wurde das Ansprechen bewertet. Die Operation bestand aus Gebärmutterentfernung mit oder ohne Lymphknotenentfernung. Bewertet wurden das Tumoransprechen, die akute und späte Bestrahlungstoxizität, die postoperative Morbidität sowie onkologische Ergebnisse.

Ergebnisse

Alle Hysterektomieproben zeigten sich makroskopisch negativ mit negativen Resektionsrändern; das pathologische Gesamtansprechen betrug 40% (Tab. 2). Bei 2 Patienten wurde ein resezierter Lymphknoten als positiv befunden. Es wurde keine übermäßige postoperative Morbidität festgestellt (Tab. 3). Es trat keine Grad-3/4-Akuttoxizität auf, abgesehen von 2 hämatologischen Grad-3-Toxizitäten. Es wurde eine intestinale Grad-4-Spättoxizität (4%) festgestellt, jedoch keine Grad-3-Spättoxizität. Urogenitale Grad-3-Spättoxizitäten entwickelten 14% der Patientinnen (n = 4; Tab. 4). Die lokalen und regionären 2-Jahres-Kontrollraten waren mit 96% bzw. 100% hoch. Die 2-Jahres-Fernkontrollrate betrug 92%. Das statistische krankheitsfreie Überleben nach 2 Jahren betrug 89%. Die statistischen 1- und 2-Jahres-Gesamtüberlebensraten betrugen 96% bzw. 91%, die 3-Jahres-Gesamtüberlebensrate 84%.

Schlussfolgerung

Eine Operation nach IMAT ± C ist durchführbar. Es ergibt sich eine niedrige postoperative Morbidität und Bestrahlungstoxizität. Dabei sind Lokal-, Regional- und Fernkontrolle sowie die Überlebensrate vielversprechend.

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Acknowledgments

This work was supported by a grant of the “Centrum voor Gezwelziekten – University Hospital Ghent”.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    K. Vandecasteele M.D., M. van Eijkeren M.D., Ph.D. & G. De Meerleer M.D., Ph.D.

  2. Department of Gynaecology, Ghent University Hospital, Ghent, Belgium

    A. Makar M.D., Ph.D., R. Van den Broecke M.D., Ph.D. & P. Tummers M.D.

  3. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    L. Delrue M.D.

  4. Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium

    H. Denys M.D., Ph.D.

  5. Department of Pathology, Ghent University Hospital, Ghent, Belgium

    K. Lambein M.D.

  6. Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

    B. Lambert M.D., Ph.D.

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  1. K. Vandecasteele M.D.
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  2. A. Makar M.D., Ph.D.
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  6. K. Lambein M.D.
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  8. M. van Eijkeren M.D., Ph.D.
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Correspondence to K. Vandecasteele M.D..

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Vandecasteele, K., Makar, A., Van den Broecke, R. et al. Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer. Strahlenther Onkol 188, 576–581 (2012). https://doi.org/10.1007/s00066-012-0097-0

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