TY - JOUR
T1 - Intensity Modulated Radiation Therapy and Image-Guided Adapted Brachytherapy for Cervix Cancer
AU - Lin, Alexander J.
AU - Kidd, Elizabeth
AU - Dehdashti, Farrokh
AU - Siegel, Barry A.
AU - Mutic, Sasa
AU - Thaker, Premal H.
AU - Massad, Leslie S.
AU - Powell, Matthew A.
AU - Mutch, David G.
AU - Markovina, Stephanie
AU - Schwarz, Julie
AU - Grigsby, Perry W.
N1 - Funding Information:
Supported by an R01 grant to J.S. from National Institutes of Health (CA181745-01) and a K12 grant to S. Markovina from National Institutes of Health (CA167540). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Conflict of interest: S. Mutic reports grants, personal fees, and nonfinancial support from Varian Medical Systems; grants, personal fees, and nonfinancial support from ViewRay; grants and nonfinancial support from Siemens; nonfinancial support and other support from Philips; other support from Radialogica; and other support from TreatSafely, outside the submitted work.
Funding Information:
Supported by an R01 grant to J.S. from National Institutes of Health ( CA181745-01 ) and a K12 grant to S. Markovina from National Institutes of Health ( CA167540 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Purpose: This study reported long-term outcomes of patients with cervical cancer who were treated with intensity modulated radiation therapy and 3-dimensional (3D) image-guided adapted brachytherapy (IMRT/3D-IGABT) compared with those treated with 2-dimensional (2D) external irradiation and 2D brachytherapy (2D EBRT/BT). Methods and Materials: This study included patients with newly diagnosed cervical cancer and pretreatment fluorodeoxyglucose positron emission tomography scans who were treated with curative-intent irradiation from 1997 to 2013. The treatment policy changed from using 2D EBRT/BT to IMRT/3D-IGABT in 2005. Patterns of recurrence, cancer-specific survival (CSS), and overall survival (OS) were evaluated. Late gastrointestinal and genitourinary toxicity were scored with National Cancer Institute Common Terminology Criteria for Adverse Events. Results: The median follow-up for patients alive at the time of last follow-up in the 2D EBRT/BT group (n = 300) was 15.3 years (range, 10.8-20.5 years). In the IMRT/3D-IGABT group (n = 300), it was 7 years (range, 5-12.4 years). According to the International Federation of Gynecology and Obstetrics, 33% of tumors were stage IB1 to IB2, 41% were stage IIA to IIB, and 26% were stage IIIA to IVA. The results after 5 years for patients treated with 2D EBRT/BT showed that freedom from relapse (FFR) was 57%, CSS was 62%, and OS was 57%. For the IMRT/3D-IGABT group, the 5-year results showed that FFR was 65% (P =.04), CSS was 69% (P =.01), and OS was 61% (P =.04). When stratified by lymph node status according to positron emission tomography scan results, disease control was most improved with IMRT/3D-IGABT versus 2D EBRT/BT in patients with positive pelvic lymph nodes only (P =.02). Cumulatively, 88 of 600 patients (15%) had grade ≥3 late bowel/bladder toxicity. The 2D EBRT/BT group had 55 patients (18%), and the IMRT/3D-IGABT group had 33 patients (11%; P =.02). Conclusions: IMRT/3D-IGABT was associated with improved survival and decreased gastrointestinal and genitourinary toxicity in patients with cervical cancer compared with those who received 2D EBRT/BT.
AB - Purpose: This study reported long-term outcomes of patients with cervical cancer who were treated with intensity modulated radiation therapy and 3-dimensional (3D) image-guided adapted brachytherapy (IMRT/3D-IGABT) compared with those treated with 2-dimensional (2D) external irradiation and 2D brachytherapy (2D EBRT/BT). Methods and Materials: This study included patients with newly diagnosed cervical cancer and pretreatment fluorodeoxyglucose positron emission tomography scans who were treated with curative-intent irradiation from 1997 to 2013. The treatment policy changed from using 2D EBRT/BT to IMRT/3D-IGABT in 2005. Patterns of recurrence, cancer-specific survival (CSS), and overall survival (OS) were evaluated. Late gastrointestinal and genitourinary toxicity were scored with National Cancer Institute Common Terminology Criteria for Adverse Events. Results: The median follow-up for patients alive at the time of last follow-up in the 2D EBRT/BT group (n = 300) was 15.3 years (range, 10.8-20.5 years). In the IMRT/3D-IGABT group (n = 300), it was 7 years (range, 5-12.4 years). According to the International Federation of Gynecology and Obstetrics, 33% of tumors were stage IB1 to IB2, 41% were stage IIA to IIB, and 26% were stage IIIA to IVA. The results after 5 years for patients treated with 2D EBRT/BT showed that freedom from relapse (FFR) was 57%, CSS was 62%, and OS was 57%. For the IMRT/3D-IGABT group, the 5-year results showed that FFR was 65% (P =.04), CSS was 69% (P =.01), and OS was 61% (P =.04). When stratified by lymph node status according to positron emission tomography scan results, disease control was most improved with IMRT/3D-IGABT versus 2D EBRT/BT in patients with positive pelvic lymph nodes only (P =.02). Cumulatively, 88 of 600 patients (15%) had grade ≥3 late bowel/bladder toxicity. The 2D EBRT/BT group had 55 patients (18%), and the IMRT/3D-IGABT group had 33 patients (11%; P =.02). Conclusions: IMRT/3D-IGABT was associated with improved survival and decreased gastrointestinal and genitourinary toxicity in patients with cervical cancer compared with those who received 2D EBRT/BT.
UR - http://www.scopus.com/inward/record.url?scp=85059685776&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2018.11.012
DO - 10.1016/j.ijrobp.2018.11.012
M3 - Article
C2 - 30445171
AN - SCOPUS:85059685776
SN - 0360-3016
VL - 103
SP - 1088
EP - 1097
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -