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Radiation Oncology

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Open Access 01-12-2014 | Research

IMRT with ¹⁸FDG-PET\CT based simultaneous integrated boost for treatment of nodal positive cervical cancer

Authors: Nikola Cihoric, Coya Tapia, Kamilla Krüger, Daniel M Aebersold, Bernd Klaeser, Kristina Lössl

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

To evaluate toxicity and outcome of intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the positive lymph nodes in patients with loco-regional advanced cervical cancer (LRACC).

Methods

The study population comprised ten patients with ¹⁸FDG-PET\CT positive lymph nodes (LNs), who underwent chemoradiation with IMRT and SIB. A dose of 50.4 Gy, in daily fractions of 1.8 Gy, was delivered to primary tumor and draining LNs. Primary tumor received an additional external beam boost to a total dose of 55.8 Gy. A SIB of 62 Gy, in daily fractions of 2 Gy, was delivered to the ¹⁸FDG-PET\CT positive LNs. Finally, a high dose rate brachytherapy (HDRB) boost (15 – 18 Gy) was administered to the primary tumor. The primary goal of this study was to evaluate acute and early late toxicity and loco-regional control.

Results

The median number of irradiated LNs per patient was 3 (range: 1–6) with a median middle nodal SIB-volume of 26.10 cm³ (range, 11.9-82.50 cm³). Median follow-up was 20 months (range, 12 to 30 months). Acute and late grade 3 toxicity was observed in 1 patient. Three of the patients developed a recurrence, one in the form of a local tumor relapse, one had a paraaortic LN metastasis outside the treated volume and the last one developed a distant metastasis.

Conclusion

IMRT with SIB in the region of 18FDG-PET positive lymph nodes appears to be an effective therapy with acceptable toxicity and might be useful in the treatment of patients with locally advanced cervical cancer.

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Rose PG: Correction - concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999,341(9):708.

Rose PG: Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999,340(15):1144-1153. 10.1056/NEJM199904153401502CrossRefPubMed

Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H (Eds): SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD; , based on November 2011 SEER data submission, posted to the SEER web site, April 2012 http://seer.cancer.gov/csr/1975_2009_pops09/

Grigsby PW, Siegel BA, Dehdashti F: Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol: J Am Soc Clin Oncol 2001,19(17):3745-3749.

Rotman M, John M, Boyce J: Prognostic factors in cervical carcinoma: implications in staging and management. Cancer 1981,48(2 Suppl):560-567.CrossRefPubMed

Grigsby PW, Perez CA, Chao KS, Herzog T, Mutch DG, Rader J: Radiation therapy for carcinoma of the cervix with biopsy-proven positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 2001,49(3):733-738. 10.1016/S0360-3016(00)00806-3CrossRefPubMed

Beadle BM, Jhingran A, Yom SS, Ramirez PT, Eifel PJ: Patterns of regional recurrence after definitive radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2010,76(5):1396-1403. 10.1016/j.ijrobp.2009.04.009CrossRefPubMed

NCCN clinical practice guidelines in oncology (NCCN guidelines) cervical cancer version 3.2013 http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf

Hasselle MD, Rose BS, Kochanski JD, Nath SK, Bafana R, Yashar CM, Hasan Y, Roeske JC, Mundt AJ, Mell LK: Clinical outcomes of intensity-modulated pelvic radiation therapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2011,80(5):1436-1445. 10.1016/j.ijrobp.2010.04.041CrossRefPubMed

10.

Vandecasteele K, De Neve W, De Gersem W, Delrue L, Paelinck L, Makar A, Fonteyne V, De Wagter C, Villeirs G, De Meerleer G: Intensity-modulated arc therapy with simultaneous integrated boost in the treatment of primary irresectable cervical cancer. Treatment planning, quality control, and clinical implementation. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft 2009,185(12):799-807. 10.1007/s00066-009-1986-8CrossRef

11.

Vandecasteele K, Makar A, Van den Broecke R, Delrue L, Denys H, Lambein K, Lambert B, van Eijkeren M, Tummers P, De Meerleer G: Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer. Toxicity, tumour response and outcome. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft 2012,188(7):576-581. 10.1007/s00066-012-0097-0CrossRef

12.

Marnitz S, Kohler C, Burova E, Wlodarczyk W, Jahn U, Grun A, Budach V, Stromberger C: Helical tomotherapy with simultaneous integrated boost after laparoscopic staging in patients with cervical cancer: analysis of feasibility and early toxicity. Int J Radiat Oncol Biol Phys 2012,82(2):e137-e143. 10.1016/j.ijrobp.2010.10.066CrossRefPubMed

13.

Guerrero M, Li XA, Ma L, Linder J, Deyoung C, Erickson B: Simultaneous integrated intensity-modulated radiotherapy boost for locally advanced gynecological cancer: radiobiological and dosimetric considerations. Int J Radiat Oncol Biol Phys 2005,62(3):933-939. 10.1016/j.ijrobp.2004.11.040CrossRefPubMed

14.

Herrera FG, Callaway S, Delikgoz-Soykut E, Coskun M, Porta L, Meuwly JY, Soares-Rodrigues J, Heym L, Moeckli R, Ozsahin M: Retrospective feasibility study of simultaneous integrated boost in cervical cancer using Tomotherapy: the impact of organ motion and tumor regression. Radiat Oncol 2013, 8: 5. 10.1186/1748-717X-8-5PubMedCentralCrossRefPubMed

15.

Beadle BM, Jhingran A, Salehpour M, Sam M, Iyer RB, Eifel PJ: Cervix regression and motion during the course of external beam chemoradiation for cervical cancer. Int J Radiat Oncol Biol Phys 2009,73(1):235-241. 10.1016/j.ijrobp.2008.03.064CrossRefPubMed

16.

Pötter R1, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J, Dumas I, Erickson B, Lang S, Nulens A, Petrow P, Rownd J, Kirisits C, GEC ESTRO Working Group: Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol: J Eur Soc Ther Radiology Oncol 2006,78(1):67-77. 10.1016/j.radonc.2005.11.014CrossRef

17.

Kidd EA, Siegel BA, Dehdashti F, Rader JS, Mutic S, Mutch DG, Powell MA, Grigsby PW: Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2010,77(4):1085-1091. 10.1016/j.ijrobp.2009.06.041CrossRefPubMed

18.

Choi HJ, Ju W, Myung SK, Kim Y: Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci 2010,101(6):1471-1479. 10.1111/j.1349-7006.2010.01532.xCrossRefPubMed

19.

Perez CA, Grigsby PW, Castro-Vita H, Lockett MA: Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys 1995,32(5):1275-1288. 10.1016/0360-3016(95)00220-SCrossRefPubMed

20.

Vandecasteele K, Tummers P, Makar A, van Eijkeren M, Delrue L, Denys H, Lambert B, Beerens AS, Van den Broecke R, Lambein K, Fonteyne V, De Meerleer G: Postoperative intensity-modulated arc therapy for cervical and endometrial cancer: a prospective report on toxicity. Int J Radiat Oncol Biol Phys 2012,84(2):408-414. 10.1016/j.ijrobp.2011.12.020CrossRefPubMed

21.

Portelance L, Chao KS, Grigsby PW, Bennet H, Low D: Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 2001,51(1):261-266. 10.1016/S0360-3016(01)01664-9CrossRefPubMed

22.

Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt AJ: Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2000,48(5):1613-1621. 10.1016/S0360-3016(00)00771-9CrossRefPubMed

23.

Chan P, Yeo I, Perkins G, Fyles A, Milosevic M: Dosimetric comparison of intensity-modulated, conformal, and four-field pelvic radiotherapy boost plans for gynecologic cancer: a retrospective planning study. Radiat Oncol 2006, 1: 13. 10.1186/1748-717X-1-13PubMedCentralCrossRefPubMed

24.

Kavanagh BD, Schefter TE, Wu Q, Tong S, Newman F, Arnfield M, Benedict SH, McCourt S, Mohan R: Clinical application of intensity-modulated radiotherapy for locally advanced cervical cancer. Semin Radiat Oncol 2002,12(3):260-271. 10.1053/srao.2002.32471CrossRefPubMed

25.

Gerszten K, Colonello K, Heron DE, Lalonde RJ, Fitian ID, Comerci JT, Selvaraj RN, Varlotto JM: Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix. Gynecol Oncol 2006,102(2):182-188. 10.1016/j.ygyno.2005.12.044CrossRefPubMed

26.

Esthappan J, Chaudhari S, Santanam L, Mutic S, Olsen J, Macdonald DM, Low DA, Singh AK, Grigsby PW: Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 2008,72(4):1134-1139. 10.1016/j.ijrobp.2008.02.063CrossRefPubMed

27.

Beriwal S, Gan GN, Heron DE, Selvaraj RN, Kim H, Lalonde R, Kelley JL, Edwards RP: Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2007,68(1):166-171. 10.1016/j.ijrobp.2006.12.023CrossRefPubMed

28.

Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C: Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997,350(9077):535-540. 10.1016/S0140-6736(97)02250-2CrossRefPubMed

29.

Landoni F, Sartori E, Maggino T, Zola P, Zanagnolo V, Cosio S, Ferrari F, Piovano E, Gadducci A: Is there a role for postoperative treatment in patients with stage Ib-IIb cervical cancer treated with neo-adjuvant chemotherapy and radical surgery? An Italian multicenter retrospective study. Gynecol Oncol 2014,132(3):611-617. 10.1016/j.ygyno.2013.12.010CrossRefPubMed

30.

Lai CH, Huang KG, Hong JH, Lee CL, Chou HH, Chang TC, Hsueh S, Huang HJ, Ng KK, Tsai CS: Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol 2003,89(1):160-167. 10.1016/S0090-8258(03)00064-7CrossRefPubMed

31.

Brockbank E, Kokka F, Bryant A, Pomel C, Reynolds K: Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer. Cochrane Database Syst Rev 2013, 3: CD008217.PubMed

32.

Chou HH, Chang TC, Yen TC, Ng KK, Hsueh S, Ma SY, Chang CJ, Huang HJ, Chao A, Wu TI, Jung SM, Wu YC, Lin CT, Huang KG, Lai CH: Low value of [18 F]-fluoro-2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy. J Clin Oncol: J Am Soc Clin Oncol 2006,24(1):123-128. 10.1200/JCO.2005.03.5964CrossRef

33.

Maduro JH, Pras E, Willemse PH, de Vries EG: Acute and long-term toxicity following radiotherapy alone or in combination with chemotherapy for locally advanced cervical cancer. Cancer Treat Rev 2003,29(6):471-488. 10.1016/S0305-7372(03)00117-8CrossRefPubMed

Title: IMRT with 18FDG-PET\CT based simultaneous integrated boost for treatment of nodal positive cervical cancer
Authors: Nikola Cihoric
Coya Tapia
Kamilla Krüger
Daniel M Aebersold
Bernd Klaeser
Kristina Lössl
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-83

Keynote webinar | Spotlight on medication adherence

Springer Medicine

IMRT with ¹⁸FDG-PET\CT based simultaneous integrated boost for treatment of nodal positive cervical cancer

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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