PURPOSE: To evaluate disease outcomes and toxicity in cervical cancer patients treated with pelvic intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: We included all patients with Stage I-IVA cervical carcinoma treated with IMRT at three different institutions from 2000-2007. Patients treated with extended field or conventional techniques were excluded. Intensity-modulated radiation therapy plans were designed to deliver 45 Gy in 1.8-Gy daily fractions to the planning target volume while minimizing dose to the bowel, bladder, and rectum. Toxicity was graded according to the Radiation Therapy Oncology Group system. Overall survival and disease-free survival were estimated by use of the Kaplan-Meier method. Pelvic failure, distant failure, and late toxicity were estimated by use of cumulative incidence functions. RESULTS: The study included 111 patients. Of these, 22 were treated with postoperative IMRT, 8 with IMRT followed by intracavitary brachytherapy and adjuvant hysterectomy, and 81 with IMRT followed by planned intracavitary brachytherapy. Of the patients, 63 had Stage I-IIA disease and 48 had Stage IIB-IVA disease. The median follow-up time was 27 months. The 3-year overall survival rate and the disease-free survival rate were 78% (95% confidence interval [CI], 68-88%) and 69% (95% CI, 59-81%), respectively. The 3-year pelvic failure rate and the distant failure rate were 14% (95% CI, 6-22%) and 17% (95% CI, 8-25%), respectively. Estimates of acute and late Grade 3 toxicity or higher were 2% (95% CI, 0-7%) and 7% (95% CI, 2-13%), respectively. CONCLUSIONS: Intensity-modulated radiation therapy is associated with low toxicity and favorable outcomes, supporting its safety and efficacy for cervical cancer. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT vs. conventional techniques.
PURPOSE: To evaluate disease outcomes and toxicity in cervical cancerpatients treated with pelvic intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: We included all patients with Stage I-IVA cervical carcinoma treated with IMRT at three different institutions from 2000-2007. Patients treated with extended field or conventional techniques were excluded. Intensity-modulated radiation therapy plans were designed to deliver 45 Gy in 1.8-Gy daily fractions to the planning target volume while minimizing dose to the bowel, bladder, and rectum. Toxicity was graded according to the Radiation Therapy Oncology Group system. Overall survival and disease-free survival were estimated by use of the Kaplan-Meier method. Pelvic failure, distant failure, and late toxicity were estimated by use of cumulative incidence functions. RESULTS: The study included 111 patients. Of these, 22 were treated with postoperative IMRT, 8 with IMRT followed by intracavitary brachytherapy and adjuvant hysterectomy, and 81 with IMRT followed by planned intracavitary brachytherapy. Of the patients, 63 had Stage I-IIA disease and 48 had Stage IIB-IVA disease. The median follow-up time was 27 months. The 3-year overall survival rate and the disease-free survival rate were 78% (95% confidence interval [CI], 68-88%) and 69% (95% CI, 59-81%), respectively. The 3-year pelvic failure rate and the distant failure rate were 14% (95% CI, 6-22%) and 17% (95% CI, 8-25%), respectively. Estimates of acute and late Grade 3 toxicity or higher were 2% (95% CI, 0-7%) and 7% (95% CI, 2-13%), respectively. CONCLUSIONS: Intensity-modulated radiation therapy is associated with low toxicity and favorable outcomes, supporting its safety and efficacy for cervical cancer. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT vs. conventional techniques.
Authors: Karen Lim; Beth Erickson; Ina M Jürgenliemk-Schulz; David Gaffney; Carien L Creutzberg; Akila Viswanathan; Lorraine Portelance; Sushil Beriwal; Aaron Wolfson; Walter Bosch; Jennifer De Los Santos; Catheryn Yashar; Anuja Jhingran; Mahesh Varia; Issam El Naqa; Bronwyn King; Anthony Fyles Journal: Pract Radiat Oncol Date: 2015-07-02
Authors: Ann H Klopp; Anamaria R Yeung; Snehal Deshmukh; Karen M Gil; Lari Wenzel; Shannon N Westin; Kent Gifford; David K Gaffney; William Small; Spencer Thompson; Desiree E Doncals; Guilherme H C Cantuaria; Brian P Yaremko; Amy Chang; Vijayananda Kundapur; Dasarahally S Mohan; Michael L Haas; Yong Bae Kim; Catherine L Ferguson; Stephanie L Pugh; Lisa A Kachnic; Deborah W Bruner Journal: J Clin Oncol Date: 2018-07-10 Impact factor: 44.544
Authors: Alexander J Lin; Elizabeth Kidd; Farrokh Dehdashti; Barry A Siegel; Sasa Mutic; Premal H Thaker; Leslie S Massad; Matthew A Powell; David G Mutch; Stephanie Markovina; Julie Schwarz; Perry W Grigsby Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-14 Impact factor: 7.038
Authors: Joseph Paul Weiner; Andrew Thomas Wong; David Schwartz; Manuel Martinez; Ayse Aytaman; David Schreiber Journal: World J Gastroenterol Date: 2016-08-21 Impact factor: 5.742