Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Long-term follow-up results of simultaneous integrated or late course accelerated boost with external beam radiotherapy to vaginal cuff for high risk cervical cancer patients after radical hysterectomy

Authors: Xin Wang, Yaqin Zhao, Yali Shen, Pei Shu, Zhiping Li, Sen Bai, Feng Xu

Published in: BMC Cancer | Issue 1/2015

Login to get access

Abstract

Background

To assess the safety and efficacy of simultaneous integrated boost (SIB) or late course accelerated boost (LCAB) with external beam radiotherapy (EBRT) to the vaginal cuff for high risk cervical cancer patients after radical hysterectomy.

Methods

Between October 2009 and January 2012, patients with high risk cervical cancer who had undergone radical surgery followed by EBRT to the vaginal cuff were enrolled. Patients were treated with either intensity modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with SIB (arm A) or IMRT/VMAT to the pelvis followed by LCAB (arm B) to vaginal cuff. In arm A, the pelvic and boost doses were 50.4 Gy and 60.2 Gy in 28 fractions, respectively. In arm B, pelvic irradiation to 50 Gy in 25 fractions followed by a boost of 9 Gy in 3 fractions were delivered. Chemotherapy was given concurrently.

Results

Overall, 80 patients were analyzed in this study (42 in arm A, 38 in arm B). In arm A and B, median follow-up was 37 and 32 months, respectively. The 3-year disease-free survival and overall survival in arms A vs B were 88.7% vs. 93.4% (p = 0.89), and 91.8% vs.100% (p = 0.21), respectively. The 3-year local-regional control and distant failure were 97.6% vs. 100% (p = 0.34), and 4.8% vs. 5.3% (p = 0.92), respectively. Grade 3–4 acute leukopenia and dermatitis were seen in 11 (26.2%) and 8 (19.0%) patients in Arm A, vs. 7 (17.8%) and 6 (15.8%) patients in Arm B, respectively (p > 0.05). Only Grade 1–2 chronic gastrointestinal (GI) and genitourinary (GU) toxicities were observed.

Conclusions

Our results indicate that both SIB and LCAB to vaginal cuff for high risk cervical cancer patients after radical hysterectomy are associated with excellent survival, local control and low toxicity.
Literature
1.
Spence AR, Goggin P, Franco EL. Process of care failures in invasive cervical cancer: systematic review and meta-analysis. Prev Med. 2007;45:93–106.CrossRefPubMed
2.
International Agency for Research on Cancer. GLOBOCAN 2008. Cancer incidence, mortality and prevalence worldwide in 2008. Available at: http://​globocan.​iarc.​fr/​. Accessed February 15, 2013.
3.
Peters 3rd WA, Liu PY, Barrett 2nd RJ, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–13.PubMed
4.
Mabuchi S, Morishige K, Isohashi F, Yoshioka Y, Takeda T, Yamamoto T, et al. Postoperative concurrent nedaplatin- based chemoradiotherapy improves survival in early-stage cervical cancer patients with adverse risk factors. Gynecol Oncol. 2009;115:482–7.CrossRefPubMed
5.
Green J, Kirwan J, Tierney J, Vale C, Symonds P, Fresco L, et al. \cervix Cochrane Database Syst Rev. 2005;3:CD002225.PubMed
6.
Small Jr W, Beriwal S, Demanes DJ, Dusenbery KE, Eifel P, Erickson B, et al. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012;11:58–67.CrossRefPubMed
7.
8.
Haas JA, Witten MR, Clancey O, Episcopia K, Accordino D, Chalas E. CyberKnife Boost for Patients with Cervical Cancer Unable to Undergo Brachytherapy. Front Oncol. 2012;2:25.CrossRefPubMedPubMedCentral
9.
Barraclough LH, Swindell R, Livsey JE, Hunter RD, Davidson SE. External beam boost for cancer of the cervix uteri when intracavitary therapy cannot be performed. Int J Radiat Oncol Biol Phys. 2008;71:772–8.CrossRefPubMed
10.
Kubicek GJ, Xue J, Xu QL, Asbell SO, Hughes L, Kramer N, et al. Stereotactic body radiotherapy as an alternative to brachytherapy in gynecologic cancer. Biomed Res Int. 2013;2013:898953.CrossRefPubMedPubMedCentral
11.
Molla M, Escude L, Nouet P, Popowski Y, Hidalgo A, Rouzaud M, et al. Fractionated stereotactic radiotherapy boost for gynecologic tumors: an alternative to brachytherapy? Int J Radiat Oncol Biol Phys. 2005;62:118–24.CrossRefPubMed
12.
Khosla D, Patel FD, Rai B, Chakraborty S, Oinam AS, Sharma SC. Dose escalation by intensity-modulated radiotherapy boost after whole pelvic radiotherapy in postoperative patients of carcinoma cervix with residual disease. Clin Oncol (R Coll Radiol). 2013;25:e1–6.CrossRef
13.
Small Jr W, Mell LK, Anderson P, Creutzberg C, De Santos Los J, Gaffney D, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71:428–34.CrossRefPubMed
14.
Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys. 2013;87:111–9.CrossRefPubMed
15.
Gunderson LL, Tepper JE. Clinical Radiation Oncology. Philadelphia: Elsevier; 2012. p. 1183–214.
16.
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;48:1613–21.CrossRefPubMed
17.
Mundt AJ, Roeske JC, Lujan AE. Intensity-modulated radiation therapy in gynecologic malignancies. Med Dosim. 2002;27:131–6.CrossRefPubMed
18.
Randall ME, Ibbott GS. Intensity-modulated radiation therapy for gynecologic cancers: pitfalls, hazards, and cautions to be considered. Semin Radiat Oncol. 2006;16:138–43.CrossRefPubMed
19.
Mundt AJ, Lujan AE, Rotmensch J, Waggoner SE, Yamada SD, Fleming G, et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;52:1330–7.CrossRefPubMed
20.
Hsieh CH, Wei MC, Lee HY, Hsiao SM, Chen CA, Wang LY, et al. Whole pelvic helical tomotherapy for locally advanced cervical cancer: technical implementation of IMRT with helical tomotherapy. Radiat Oncol. 2009;4:62.CrossRefPubMedPubMedCentral
21.
Hasselle MD, Rose BS, Kochanski JD, Nath SK, Bafana R, Yashar CM, et al. Clinical outcomes of intensity- modulated pelvic radiation therapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 2011;80:1436–45.CrossRefPubMed
22.
Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol. 2008;89:180–91.CrossRefPubMed
23.
Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, et al. Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol. 2009;92:118–24.CrossRefPubMed
24.
Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol. 2009;92:111–7.CrossRefPubMed
25.
Verbakel WF, Cuijpers JP, Hoffmans D, Bieker M, Slotman BJ, Senan S. Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys. 2009;74:252–9.CrossRefPubMed
26.
Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol. 1999;73:177–83.CrossRefPubMed
27.
Ryu HS, Chun M, Chang KH, Chang HJ, Lee JP. Postoperative adjuvant concurrent chemoradiotherapy improves survival rates for high-risk, early stage cervical cancer patients. Gynecol Oncol. 2005;96:490–5.CrossRefPubMed
28.
Kodama J, Seki N, Nakamura K, Hongo A, Hiramatsu Y. Prognostic factors in pathologic parametrium-positive patients with stage IB-IIB cervical cancer treated by radical surgery and adjuvant therapy. Gynecol Oncol. 2007;105:757–61.CrossRefPubMed
29.
Folkert MR, Shih KK, Abu-Rustum NR, Jewell E, Kollmeier MA, Makker V, et al. Postoperative pelvic intensity- modulated radiotherapy and concurrent chemotherapy in intermediate- and high- risk cervical cancer. Gynecol Oncol. 2013;128:288–93.CrossRefPubMed
30.
Chen MF, Tseng CJ, Tseng CC, Yu CY, Wu CT, Chen WC. Adjuvant concurrent chemoradiotherapy with intensity-modulated pelvic radiotherapy after surgery for high-risk, early stage cervical cancer patients. Cancer J. 2008;14:200–6.CrossRefPubMed
31.
Chen MF, Tseng CJ, Tseng CC, Kuo YC, Yu CY, Chen WC. Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: comparison with conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67:1438–44.CrossRefPubMed
32.
Pieterse QD, Trimbos JB, Dijkman A, Creutzberg CL, Gaarenstroom KN, Peters AA, et al. Postoperative radiation therapy improves prognosis in patients with adverse risk factors in localized, early-stage cervical cancer: a retrospective comparative study. Int J Gynecol Cancer. 2006;16:1112–8.CrossRefPubMed
33.
Beriwal S, Jain SK, Heron DE, Kim H, Gerszten K, Edwards RP, et al. Clinical outcome with adjuvant treatment of endometrial carcinoma using intensity-modulated radiation therapy. Gynecol Oncol. 2006;102:195–9.CrossRefPubMed
34.
Gerszten K, Colonello K, Heron DE, Lalonde RJ, Fitian ID, Comerci JT, et al. Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix. Gynecol Oncol. 2006;102:182–8.CrossRefPubMed
35.
Mell LK, Kochanski JD, Roeske JC, Haslam JJ, Mehta N, Yamada SD, et al. Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:1356–65.CrossRefPubMed
Metadata
Title
Long-term follow-up results of simultaneous integrated or late course accelerated boost with external beam radiotherapy to vaginal cuff for high risk cervical cancer patients after radical hysterectomy
Authors
Xin Wang
Yaqin Zhao
Yali Shen
Pei Shu
Zhiping Li
Sen Bai
Feng Xu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1248-3

Other articles of this Issue 1/2015

BMC Cancer 1/2015 Go to the issue

Research article

Epidermal growth factor receptor gene mutation status in pure squamous-cell lung cancer in Chinese patients

Research article

Risk of cancer among HIV-infected patients from a population-based nested case–control study: implications for cancer prevention

Research article

Cancer incidence in patients with type 2 diabetes mellitus: a population-based cohort study in Shanghai

Research article

Phosphorylation of pyruvate kinase M2 and lactate dehydrogenase A by fibroblast growth factor receptor 1 in benign and malignant thyroid tissue

Research article

Mice null for the deubiquitinase USP18 spontaneously develop leiomyosarcomas

Research article

The Functionality Assessment Flowchart (FAF): a new simple and reliable method to measure performance status with a high percentage of agreement between observers
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits