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

摘要

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