Clinical efficacy and toxicity of radio-chemotherapy and magnetic resonance imaging-guided brachytherapy for locally advanced cervical cancer patients: A mono-institutional experience

• DOI: 10.3109/0284186x.2015.1062542
• Publication Date: 2015-09-25T20:48:18Z
• Authors: Ferenc Lakosi; Marjoelin de Cuypere; Paul Viet Nguyen; Nicolas Jansen; Bernard Warlimont; Akos Gulyban; Christine Gennigens; Laurence Seidel; Katty Delbecque; Philippe Coucke; Johanne Hermesse; Frederic Kridelka
• Keywords: Adult; Organs at Risk; Brachytherapy; Rectum; Antineoplastic Agents; Chemoradiotherapy; Middle Aged; Radiation Dosage; Hematologic Diseases; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Colon, Sigmoid; Lymphatic Metastasis; Carcinoma, Squamous Cell; Humans; Female; Dose Fractionation, Radiation; Radiotherapy, Intensity-Modulated; Cisplatin; Aged; Neoplasm Staging

To evaluate efficacy and toxicity of radio-chemotherapy (RCT) MR-guided pulsed-dose-rate (PDR) adaptive brachytherapy (IGABT) for locally advanced cervical cancer (LACC).Between 2007 2014 85 patients with FIGO stage 1B1 N+ or ≥ 1B2 were treated RCT+ IGABT. The treatment consisted a pelvic± paraaortic external beam radiotherapy (EBRT) (45-50.4 Gy ± 10 boost to primary tumor and/or pathologic lymph nodes) concurrent cisplatin followed by 25-35 PDR IGABT in 30-50 pulses. ratio 3D-CFRT/IMRT was 61/24 patients. Dose-volume parameters high-risk clinical target volume (HR-CTV), intermediate-risk (IR-CTV) D2cm(3) organs at risk (OARs) reported. Local control (LC), cancer-specific survival (CCS) overall (OS) analyzed actuarially morbidity crude rates scored using CTCAEv4.0.Mean follow-up 36 months (range 6-94). mean D90 D98 HR-CTV 84.4 9 77 8.1 Gy, while IR-CTV 69.1 4.3 64.8 respectively. OARs the following: bladder: 77.3 10.5 rectum: 65 6.8 sigmoid: 63 7.9 intestine: 64.0 9.1 Gy. Three year LC, CSS OS were: 94%, 85% 81%. three-year regional- distant 95% 74%. Node negative had significantly higher (100 vs. 72%, p = 0.016) (92 0.001) compared node positive ones. Three-year actuarial late Grade 3 GI: 8%, GU: 5%, Vaginal: 8%. frequency hematological toxicities including anemia/leukopenia/neutropenia/thrombocytopenia 8.6%/34.7%/24.3%/24.3%, respectively.This large mono-institutional experience builds up further evidences that conjunction RCT should be standard care suffering LACC.