Naoya Murakami1, Ken Ando2, Masumi Murata3, Kazutoshi Murata4, Tatsuya Ohno5, Tomomi Aoshika6, Shingo Kato6, Noriyuki Okonogi7, Anneyuko I Saito8, Joo-Young Kim9, Yasuko Kumai10, Yasuo Yoshioka10, Shuhei Sekii11, Kayoko Tsujino12, Chairat Lowanichkiattikul13, Poompis Pattaranutaporn13, Yuko Kaneyasu14, Tomio Nakagawa14, Miho Watanabe15, Takashi Uno15, Rei Umezawa16, Keiichi Jingu16, Ayae Kanemoto17, Masaru Wakatsuki18, Katsuyuki Shirai19, Hiroshi Igaki20, Jun Itami21. 1. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan. Electronic address: namuraka@ncc.go.jp. 2. Department of Radiation Oncology, Gunma Prefectural Cancer Center, Gunma, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan. 3. Department of Radiation Oncology, Gunma Prefectural Cancer Center, Gunma, Japan. 4. Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan; QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan. 5. Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan. 6. Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan. 7. QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan. 8. Department of Radiology, Juntendo University Faculty of Medicine, Tokyo, Japan. 9. Department of Radiation Oncology, National Cancer Center, Goyang, Republic of Korea. 10. Radiation Oncology Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. 11. Department of Radiation Oncology, Hyogo Cancer Center, Hyogo, Japan; Department of Radiation Therapy, Kita-Harima Medical Center, Hyogo, Japan. 12. Department of Radiation Oncology, Hyogo Cancer Center, Hyogo, Japan. 13. Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 14. Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, Hiroshima, Japan. 15. Department of Radiology, Chiba University Hospital, Chiba, Japan. 16. Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Miyagi, Japan. 17. Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan. 18. QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan; Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan. 19. Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan. 20. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan. Electronic address: hirigaki@ncc.go.jp. 21. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
Abstract
OBJECTIVE: The majority of uterine cervical cancer is known to be related to human papillomavirus (HPV), and HPV-related tumors are known to be radio-sensitive. In the management of HPV-related oropharyngeal cancer, de-intensification of treatment has been attempted; however, no such attempt is performed in the management of cervical cancer. The aim of this study was to identify a group of patients who can safely be treated by de-escalated treatment intensity. METHODS: From the Asian international multi-institutional retrospective study involving 13 Japanese, one Thailand, and one Korean institutions based on 469 patients, squamous cell carcinoma (Scc), tumor reduction ratio ≥29%, tumor size before brachytherapy ≤4 cm, and total treatment time (TTT) <9 weeks were identified as factors having an influence on local control. Based on these findings, low-risk patients having these four factors were extracted, and treatment outcomes categorized in 10 Gy increment of CTVHR D90 were compared. RESULTS: Among 469 patients, 162 patients (34.5%) met the criteria of low-risk group, and 63, 41, 43, and 15 patients were categorized in CTVHR D90 50-60 Gy, 60-70 Gy, 70-80 Gy, and >80 Gy, respectively. While 4-y progression-free survival ranged from 66 to 80%, 4-y local control was consistently over 90% in every dose group. Rectum and bladder D2cc and incidence of late adverse events decreased as CTVHR D90 decreased. CONCLUSIONS: The low-risk patients achieved favorable local control with CTVHR D90 <80 Gy. A personalized treatment strategy based on tumor response could also be adopted for cervical cancer.
OBJECTIVE: The majority of uterine cervical cancer is known to be related to human papillomavirus (HPV), and HPV-related tumors are known to be radio-sensitive. In the management of HPV-related oropharyngeal cancer, de-intensification of treatment has been attempted; however, no such attempt is performed in the management of cervical cancer. The aim of this study was to identify a group of patients who can safely be treated by de-escalated treatment intensity. METHODS: From the Asian international multi-institutional retrospective study involving 13 Japanese, one Thailand, and one Korean institutions based on 469 patients, squamous cell carcinoma (Scc), tumor reduction ratio ≥29%, tumor size before brachytherapy ≤4 cm, and total treatment time (TTT) <9 weeks were identified as factors having an influence on local control. Based on these findings, low-risk patients having these four factors were extracted, and treatment outcomes categorized in 10 Gy increment of CTVHR D90 were compared. RESULTS: Among 469 patients, 162 patients (34.5%) met the criteria of low-risk group, and 63, 41, 43, and 15 patients were categorized in CTVHR D90 50-60 Gy, 60-70 Gy, 70-80 Gy, and >80 Gy, respectively. While 4-y progression-free survival ranged from 66 to 80%, 4-y local control was consistently over 90% in every dose group. Rectum and bladder D2cc and incidence of late adverse events decreased as CTVHR D90 decreased. CONCLUSIONS: The low-risk patients achieved favorable local control with CTVHR D90 <80 Gy. A personalized treatment strategy based on tumor response could also be adopted for cervical cancer.