Intensity-modulated Radiation Therapy with the Central Shielding Technique for Patients with Uterine Cervical Cancer†

Overview

Journal J Radiat Res

Publisher Oxford University Press

Specialties Environmental Health
Oncology
Radiology

Date 2023 Jun 15

PMID 37321676

Authors

Akira Torii

Natsuo Tomita

Mayu Kuno

Masahiro Nishio

Yuki Yamada

Taiki Takaoka

Dai Okazaki

Masanari Niwa

Nozomi Kita

Seiya Takano

Takayuki Murao

Yasutaka Ogawa

Akio Hiwatashi

Affiliations

Soon will be listed here.

Abstract

We aimed to examine outcomes and toxicities of intensity-modulated radiation therapy (IMRT) with the central shielding (CS) technique for patients with uterine cervical cancer. This retrospective study included 54 patients with International Federation of Gynecology and Obstetrics IB-IVA cancer. Whole pelvic radiotherapy or extended-field radiotherapy were performed at the dose of 50.4 Gy in 28 fractions with helical tomotherapy (HT). Six patients had para-aortic lymph node metastases. The CS technique with HT was utilized after a total dose of 28.8-41.4 Gy to reduce doses to the rectum and bladder. The prescribed dose of intracavitary brachytherapy was mainly 18-24 Gy in three or four fractions at point A. Concurrent chemotherapy was used for 47 patients (87%). Median follow-up time was 56 months. Seventeen patients (31%) developed recurrence. The recurrence of the cervix was observed in two patients (4%). The 5-year rates of the locoregional control, progression-free survival (PFS) and overall survival were 79, 66 and 82%, respectively. Among several factors evaluated, histological type of adenocarcinoma was only a significantly worse prognostic factor for PFS by multivariate analysis (hazard ratio, 4.9 [95% confidence interval, 1.3-18], P = 0.018). Grade 2 or higher late toxicities were observed in nine patients (17%). Two patients (4%) each had grade 3 proctitis and grade 3 ileus, respectively. No grade 4 toxicity or treatment-related death was observed. The results suggest that IMRT with the CS technique allows a high local control without increasing the risk of complications for cervical cancer patients.

References

Bondar M, Hoogeman M, Mens J, Quint S, Ahmad R, Dhawtal G . Individualized nonadaptive and online-adaptive intensity-modulated radiotherapy treatment strategies for cervical cancer patients based on pretreatment acquired variable bladder filling computed tomography scans. Int J Radiat Oncol Biol Phys. 2012; 83(5):1617-23. DOI: 10.1016/j.ijrobp.2011.10.011. View

Jemal A, Bray F, Center M, Ferlay J, Ward E, Forman D . Global cancer statistics. CA Cancer J Clin. 2011; 61(2):69-90. DOI: 10.3322/caac.20107. View

Mukai Y, Minagawa Y, Inoue H, Sato A, Matsui K, Fukuda T . Treatment Outcome of the Combination Therapy of High-dose rate Intracavitary Brachytherapy and Intensity-modulated Radiation Therapy With Central-shielding for Cervical Cancer. In Vivo. 2020; 34(6):3387-3398. PMC: 7811600. DOI: 10.21873/invivo.12177. View

Nakano T, Kato S, Ohno T, Tsujii H, Sato S, Fukuhisa K . Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix. Cancer. 2004; 103(1):92-101. DOI: 10.1002/cncr.20734. View

Mizuno T, Tomita N, Takaoka T, Tomida M, Fukuma H, Tsuchiya T . Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp. Technol Cancer Res Treat. 2021; 20:1533033820985866. PMC: 7871283. DOI: 10.1177/1533033820985866. View

Toita T, Kato S, Niibe Y, Ohno T, Kazumoto T, Kodaira T . Prospective multi-institutional study of definitive radiotherapy with high-dose-rate intracavitary brachytherapy in patients with nonbulky (<4-cm) stage I and II uterine cervical cancer (JAROG0401/JROSG04-2). Int J Radiat Oncol Biol Phys. 2011; 82(1):e49-56. DOI: 10.1016/j.ijrobp.2011.01.022. View

Toita T, Ohno T, Kaneyasu Y, Kato T, Uno T, Hatano K . A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer. Jpn J Clin Oncol. 2011; 41(9):1119-26. DOI: 10.1093/jjco/hyr096. View

Tamaki T, Hirai R, Igari M, Kumazaki Y, Noda S, Suzuki Y . Dosimetric comparison of three-dimensional conformal radiotherapy versus volumetric-arc radiotherapy in cervical cancer treatment: applying the central-shielding principle to modern technology. J Radiat Res. 2018; 59(5):639-648. PMC: 6151642. DOI: 10.1093/jrr/rry054. View

Gandhi A, Sharma D, Rath G, Julka P, Subramani V, Sharma S . Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys. 2013; 87(3):542-8. DOI: 10.1016/j.ijrobp.2013.06.2059. View

10.

Kidd E, Siegel B, Dehdashti F, Rader J, Mutic S, Mutch D . 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. 2009; 77(4):1085-91. DOI: 10.1016/j.ijrobp.2009.06.041. View

11.

Kato S, Ohno T, Thephamongkhol K, Chansilpa Y, Yuxing Y, Devi C . Multi-institutional phase II clinical study of concurrent chemoradiotherapy for locally advanced cervical cancer in East and Southeast Asia. Int J Radiat Oncol Biol Phys. 2009; 77(3):751-7. DOI: 10.1016/j.ijrobp.2009.06.011. View

12.

Cihoric N, Tapia C, Kruger K, Aebersold D, Klaeser B, Lossl K . IMRT with ¹⁸FDG-PET\CT based simultaneous integrated boost for treatment of nodal positive cervical cancer. Radiat Oncol. 2014; 9:83. PMC: 4014138. DOI: 10.1186/1748-717X-9-83. View

13.

Kadoya N, Miyasaka Y, Yamamoto T, Kuroda Y, Ito K, Chiba M . Evaluation of rectum and bladder dose accumulation from external beam radiotherapy and brachytherapy for cervical cancer using two different deformable image registration techniques. J Radiat Res. 2017; 58(5):720-728. PMC: 5737357. DOI: 10.1093/jrr/rrx028. View

14.

Toita T, Ohno T, Kaneyasu Y, Uno T, Yoshimura R, Kodaira T . A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer. Jpn J Clin Oncol. 2010; 40(5):456-63. DOI: 10.1093/jjco/hyp191. View

15.

Choi K, Kim J, Lee D, Lee Y, Lee S, Sung S . Clinical impact of boost irradiation to pelvic lymph node in uterine cervical cancer treated with definitive chemoradiotherapy. Medicine (Baltimore). 2018; 97(16):e0517. PMC: 5916705. DOI: 10.1097/MD.0000000000010517. View

16.

Gordon J, Weiss E, Abayomi O, Siebers J, Dogan N . The effect of uterine motion and uterine margins on target and normal tissue doses in intensity modulated radiation therapy of cervical cancer. Phys Med Biol. 2011; 56(10):2887-901. PMC: 3167169. DOI: 10.1088/0031-9155/56/10/001. View

17.

Potter R, Tanderup K, Schmid M, Jurgenliemk-Schulz I, Haie-Meder C, Fokdal L . MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. Lancet Oncol. 2021; 22(4):538-547. DOI: 10.1016/S1470-2045(20)30753-1. View

18.

Kusada T, Toita T, Ariga T, Kudaka W, Maemoto H, Makino W . Definitive radiotherapy consisting of whole pelvic radiotherapy with no central shielding and CT-based intracavitary brachytherapy for cervical cancer: feasibility, toxicity, and oncologic outcomes in Japanese patients. Int J Clin Oncol. 2020; 25(11):1977-1984. PMC: 7572338. DOI: 10.1007/s10147-020-01736-4. View

19.

Tomita N, Soga N, Ogura Y, Furusawa J, Tanaka H, Koide Y . Favorable 10-year outcomes of image-guided intensity-modulated radiotherapy combined with long-term androgen deprivation for Japanese patients with nonmetastatic prostate cancer. Asia Pac J Clin Oncol. 2018; 15(1):18-25. DOI: 10.1111/ajco.13097. View

20.

Hirai R, Tamaki T, Igari M, Kumazaki Y, Noda S, Kato S . Plan-Optimization Method for Central-shielding Pelvic Volumetric-modulated Arc Therapy for Cervical Cancer. In Vivo. 2020; 34(6):3611-3618. PMC: 7811628. DOI: 10.21873/invivo.12206. View