Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

Overview

Journal Pract Radiat Oncol

Publisher Elsevier

Specialties Oncology
Radiology

Date 2020 Jun 1

PMID 32473857

Citations 69

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

Affiliations

Soon will be listed here.

Abstract

Purpose: This guideline reviews the evidence and provides recommendations for the indications and appropriate techniques of radiation therapy (RT) in the treatment of nonmetastatic cervical cancer.

Methods: The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT in definitive and postoperative management of cervical cancer. These questions included the indications for postoperative and definitive RT, the use of chemotherapy in sequence or concurrent with RT, the use of intensity modulated radiation therapy (IMRT), and the indications and techniques of brachytherapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.

Results: The guideline recommends postoperative RT for those with intermediate risk factors, and chemoradiation for those with high-risk factors. In the definitive setting, chemoradiation is recommended for stages IB3-IVA, and RT or chemoradiation is conditionally recommended for stages IA1-IB2 if medically inoperable. IMRT is recommended for postoperative RT and conditionally recommended for definitive RT, for the purposes of reducing acute and late toxicity. Brachytherapy is strongly recommended for all women receiving definitive RT, and several recommendations are made for target dose and fractionation, the use of intraoperative imaging, volume-based planning, and recommendations for doses limits for organs at risk.

Conclusions: There is strong evidence supporting the use of RT with or without chemotherapy in both definitive and postoperative settings. Brachytherapy is an essential part of definitive management and volumetric planning is recommended. IMRT may be used for the reduction of acute and late toxicity. The use of radiation remains an essential component for women with cervical cancer to achieve cure.

Citing Articles

External beam radiotherapy followed by image-guided adaptive brachytherapy in locally advanced cervical cancer: a multicenter retrospective analysis.

Cena S, Olivero F, Martini S, Gianello L, Boriano A, Merlotti A Radiol Med. 2024; 129(12):1906-1915.

PMID: 39448439 DOI: 10.1007/s11547-024-01899-4.

Barriers to Implementing a Quality Improvement Program in Low- and Middle-Income Countries: Adequacy of Resources.

Pain D, MacDuffie E, Martei Y, Kassick M, Ikeda D, Shulman L JCO Glob Oncol. 2024; 10:e2400114.

PMID: 39447091 PMC: 11529835. DOI: 10.1200/GO.24.00114.

Novel use of adjuvant proton beam therapy in patient with pelvic renal transplant diagnosed with stage IB3 cervical adenocarcinoma.

Versuti Del Cioppo Vasques P, Bakkum-Gamez J, Dean P, Molligan J, Garda A Gynecol Oncol Rep. 2024; 56:101520.

PMID: 39421440 PMC: 11483286. DOI: 10.1016/j.gore.2024.101520.

Dose escalation with stereotactic body radiotherapy for cervical cancer treatment.

Turna M, Rzazade R, Kucukmorkoc E, Kucuk N, Canoglu M, Caglar H BMC Cancer. 2024; 24(1):1281.

PMID: 39407149 PMC: 11481774. DOI: 10.1186/s12885-024-13017-8.

Retrospective assessment of HDR brachytherapy dose calculation methods in locally advanced cervical cancer patients: AcurosBV vs. AAPM TG43 formalism.

Radcliffe B, Kim Y, Raffi J, Ayala-Peacock D, Stephens S, Chino J J Appl Clin Med Phys. 2024; 26(1):e14549.

PMID: 39382834 PMC: 11712453. DOI: 10.1002/acm2.14549.

References

Mazeron R, Castelnau-Marchand P, Escande A, Rivin Del Campo E, Maroun P, Lefkopoulos D . Tumor dose-volume response in image-guided adaptive brachytherapy for cervical cancer: A meta-regression analysis. Brachytherapy. 2016; 15(5):537-42. DOI: 10.1016/j.brachy.2016.05.009. View

Poorvu P, Sadow C, Townamchai K, Damato A, Viswanathan A . Duodenal and other gastrointestinal toxicity in cervical and endometrial cancer treated with extended-field intensity modulated radiation therapy to paraaortic lymph nodes. Int J Radiat Oncol Biol Phys. 2012; 85(5):1262-8. DOI: 10.1016/j.ijrobp.2012.10.004. View

Sturdza A, Potter R, Fokdal L, Haie-Meder C, Tan L, Mazeron R . Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol. 2016; 120(3):428-433. DOI: 10.1016/j.radonc.2016.03.011. View

Kirchheiner K, Nout R, Tanderup K, Lindegaard J, Westerveld H, Haie-Meder C . Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study. Int J Radiat Oncol Biol Phys. 2014; 89(1):88-95. DOI: 10.1016/j.ijrobp.2014.01.032. View

Ioffe Y, Hillen T, Zhou G, Schwarz J, Massad L, Powell M . Postradiation damage to the pelvic girdle in cervical cancer patients: is intensity-modulated radiation therapy safer than conventional radiation?. Int J Gynecol Cancer. 2014; 24(4):806-12. DOI: 10.1097/IGC.0000000000000117. View

Whitney C, Sause W, Bundy B, MALFETANO J, Hannigan E, Fowler Jr W . Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999; 17(5):1339-48. DOI: 10.1200/JCO.1999.17.5.1339. View

Falcetta F, Medeiros L, Edelweiss M, Pohlmann P, Stein A, Rosa D . Adjuvant platinum-based chemotherapy for early stage cervical cancer. Cochrane Database Syst Rev. 2016; 11:CD005342. PMC: 6473195. DOI: 10.1002/14651858.CD005342.pub4. View

Gill B, Kim H, Houser C, Kelley J, Sukumvanich P, Edwards R . MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: the University of Pittsburgh experience. Int J Radiat Oncol Biol Phys. 2015; 91(3):540-7. DOI: 10.1016/j.ijrobp.2014.10.053. View

Rijkmans E, Nout R, Rutten I, Ketelaars M, Neelis K, Laman M . Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy. Gynecol Oncol. 2014; 135(2):231-8. DOI: 10.1016/j.ygyno.2014.08.027. View

10.

Wakatsuki M, Kato S, Ohno T, Banu P, Hoang N, Yadamsuren E . Multi-institutional Observational Study of Prophylactic Extended-Field Concurrent Chemoradiation Therapy Using Weekly Cisplatin for Patients With Pelvic Node-Positive Cervical Cancer in East and Southeast Asia. Int J Radiat Oncol Biol Phys. 2019; 105(1):183-189. DOI: 10.1016/j.ijrobp.2019.04.039. View

11.

Karlsson J, Dreifaldt A, Mordhorst L, Sorbe B . Differences in outcome for cervical cancer patients treated with or without brachytherapy. Brachytherapy. 2016; 16(1):133-140. DOI: 10.1016/j.brachy.2016.09.011. View

12.

Mayadev J, Viswanathan A, Liu Y, Li C, Albuquerque K, Damato A . American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer. Brachytherapy. 2017; 16(1):22-43. PMC: 5497694. DOI: 10.1016/j.brachy.2016.03.008. View

13.

Grigsby P, Heydon K, Mutch D, Kim R, Eifel P . Long-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys. 2001; 51(4):982-7. DOI: 10.1016/s0360-3016(01)01723-0. View

14.

Dimopoulos J, Lang S, Kirisits C, Fidarova E, Berger D, Georg P . Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys. 2009; 75(1):56-63. DOI: 10.1016/j.ijrobp.2008.10.033. View

15.

Potter R, Dimopoulos J, Georg P, Lang S, Waldhausl C, Wachter-Gerstner N . Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol. 2007; 83(2):148-55. DOI: 10.1016/j.radonc.2007.04.012. View

16.

Georg P, Potter R, Georg D, Lang S, Dimopoulos J, Sturdza A . Dose effect relationship for late side effects of the rectum and urinary bladder in magnetic resonance image-guided adaptive cervix cancer brachytherapy. Int J Radiat Oncol Biol Phys. 2011; 82(2):653-7. DOI: 10.1016/j.ijrobp.2010.12.029. View

17.

Yang J, Yin J, Yan G, Huang D, Wang J . Postoperative chemoradiotherapy versus radiotherapy alone for cervical cancer: A systematic review and meta-analysis. J Obstet Gynaecol. 2016; 36(5):641-8. DOI: 10.3109/01443615.2015.1134458. View

18.

Cetina L, Gonzalez-Enciso A, Cantu D, Coronel J, Perez-Montiel D, Hinojosa J . Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients. Ann Oncol. 2013; 24(8):2043-7. DOI: 10.1093/annonc/mdt142. View

19.

Mahantshetty U, Krishnatry R, Hande V, Jamema S, Ghadi Y, Engineer R . Magnetic Resonance Image Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer: An Experience From a Tertiary Cancer Center in a Low and Middle Income Countries Setting. Int J Radiat Oncol Biol Phys. 2017; 99(3):608-617. DOI: 10.1016/j.ijrobp.2017.06.010. View

20.

Jensen N, Potter R, Kirchheiner K, Fokdal L, Lindegaard J, Kirisits C . Bowel morbidity following radiochemotherapy and image-guided adaptive brachytherapy for cervical cancer: Physician- and patient reported outcome from the EMBRACE study. Radiother Oncol. 2018; 127(3):431-439. DOI: 10.1016/j.radonc.2018.05.016. View