Alexander J Lin1, Elizabeth Kidd2, Farrokh Dehdashti3, Barry A Siegel3, Sasa Mutic1, Premal H Thaker4, Leslie S Massad4, Matthew A Powell4, David G Mutch4, Stephanie Markovina1, Julie Schwarz1, Perry W Grigsby5. 1. Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri. 2. Department of Radiation Oncology, Stanford University, Stanford, California. 3. Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. 4. Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri. 5. Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. Electronic address: pgrigsby@wustl.edu.
Abstract
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.
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.
Authors: Stéphanie Smet; Richard Pötter; Christine Haie-Meder; Jacob C Lindegaard; Ina Schulz-Juergenliemk; Umesh Mahantshetty; Barbara Segedin; Kjersti Bruheim; Peter Hoskin; Bhavana Rai; Fleur Huang; Rachel Cooper; Erik van Limbergen; Kari Tanderup; Kathrin Kirchheiner Journal: Radiother Oncol Date: 2018-04-05 Impact factor: 6.280
Authors: Nina Boje Kibsgaard Jensen; Richard Pötter; Kathrin Kirchheiner; Lars Fokdal; Jacob Christian Lindegaard; Christian Kirisits; Renaud Mazeron; Umesh Mahantshetty; Ina Maria Jürgenliemk-Schulz; Barbara Segedin; Peter Hoskin; Kari Tanderup Journal: Radiother Oncol Date: 2018-06-04 Impact factor: 6.280
Authors: Arno J Mundt; Anthony E Lujan; Jacob Rotmensch; Steven E Waggoner; S Diane Yamada; Gini Fleming; John C Roeske Journal: Int J Radiat Oncol Biol Phys Date: 2002-04-01 Impact factor: 7.038
Authors: Sushil Beriwal; Gregory N Gan; Dwight E Heron; Raj N Selvaraj; Hayeon Kim; Ron Lalonde; Joseph L Kelley; Robert P Edwards Journal: Int J Radiat Oncol Biol Phys Date: 2007-02-22 Impact factor: 7.038
Authors: Loren K Mell; Igor Sirák; Lichun Wei; Rafal Tarnawski; Umesh Mahantshetty; Catheryn M Yashar; Michael T McHale; Ronghui Xu; Gordon Honerkamp-Smith; Ruben Carmona; Mary Wright; Casey W Williamson; Linda Kasaová; Nan Li; Stephen Kry; Jeff Michalski; Walter Bosch; William Straube; Julie Schwarz; Jessica Lowenstein; Steve B Jiang; Cheryl C Saenz; Steve Plaxe; John Einck; Chonlakiet Khorprasert; Paul Koonings; Terry Harrison; Mei Shi; A J Mundt Journal: Int J Radiat Oncol Biol Phys Date: 2016-11-23 Impact factor: 7.038
Authors: Jacqueline E Zoberi; Jose Garcia-Ramirez; Yanle Hu; Baozhou Sun; Carol G Bertelsman; Pawel Dyk; Julie K Schwarz; Perry W Grigsby Journal: J Appl Clin Med Phys Date: 2016-01-08 Impact factor: 2.102
Authors: A J Lin; F Dehdashti; L S Massad; P H Thaker; M A Powell; D G Mutch; J K Schwarz; S Markovina; B A Siegel; P W Grigsby Journal: Clin Oncol (R Coll Radiol) Date: 2021-02-11 Impact factor: 4.126
Authors: Junzo Chino; Christina M Annunziata; Sushil Beriwal; Lisa Bradfield; Beth A Erickson; Emma C Fields; KathrynJane Fitch; Matthew M Harkenrider; Christine H Holschneider; Mitchell Kamrava; Eric Leung; Lilie L Lin; Jyoti S Mayadev; Marc Morcos; Chika Nwachukwu; Daniel Petereit; Akila N Viswanathan Journal: Pract Radiat Oncol Date: 2020-05-18
Authors: David S Lakomy; Juliana Wu; Bhavana V Chapman; Zhiqian Henry Yu; Belinda Lee; Ann H Klopp; Anuja Jhingran; Patricia J Eifel; Lilie L Lin Journal: Pract Radiat Oncol Date: 2021-12-25