IMRT COMPARED WITH 4 FIELD CONFORMAL PELVIC RADIOTHERAPY FOR THE DEFINITIVE TREATMENT OF CERVICAL CANCER

2009 ◽  
Vol 92 ◽  
pp. S90-S91
Author(s):  
J. Forrest ◽  
J. Presutti ◽  
M. Davidson ◽  
P. Hamilton ◽  
G. Thomas
Keyword(s):  
Cervical Cancer ◽  
Definitive Treatment ◽  
Pelvic Radiotherapy

scholarly journals Diagnostic efficiency of whole-body 18F-FDG PET/MRI, MRI alone, and SUV and ADC values in staging of primary uterine cervical cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aida Steiner ◽  
Sara Narva ◽  
Irina Rinta-Kiikka ◽  
Sakari Hietanen ◽  
Johanna Hynninen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Fdg Pet ◽  
Standardized Uptake Value ◽  
Distant Metastases ◽  
Added Value ◽  
Whole Body ◽  
Definitive Treatment ◽  
Nodal Involvement ◽  
Local Tumor ◽  
Tumor Spread

Abstract Background The use of PET/MRI for gynecological cancers is emerging. The purpose of this study was to assess the additional diagnostic value of PET over MRI alone in local and whole-body staging of cervical cancer, and to evaluate the benefit of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) in staging. Methods Patients with histopathologically-proven cervical cancer and whole-body 18F-FDG PET/MRI obtained before definitive treatment were retrospectively registered. Local tumor spread, nodal involvement, and distant metastases were evaluated using PET/MRI or MRI dataset alone. Histopathology or clinical consensus with follow-up imaging were used as reference standard. Tumor SUVmax and ADC were measured and SUVmax/ADC ratio calculated. Area under the curve (AUC) was determined to predict diagnostic performance and Mann-Whitney U test was applied for group comparisons. Results In total, 33 patients who underwent surgery (n = 23) or first-line chemoradiation (n = 10) were included. PET/MRI resulted in higher AUC compared with MRI alone in detecting parametrial (0.89 versus 0.73), vaginal (0.85 versus 0.74), and deep cervical stromal invasion (0.96 versus 0.74), respectively. PET/MRI had higher diagnostic confidence than MRI in identifying patients with radical cone biopsy and no residual at hysterectomy (sensitivity 89% versus 44%). PET/MRI and MRI showed equal AUC for pelvic nodal staging (both 0.73), whereas AUC for distant metastases was higher using PET/MRI (0.80 versus 0.67). Tumor SUVmax/ADC ratio, but not SUVmax or ADC alone, was significantly higher in the presence of metastatic pelvic lymph nodes (P < 0.05). Conclusions PET/MRI shows higher accuracy than MRI alone for determining local tumor spread and distant metastasis emphasizing the added value of PET over MRI alone in staging of cervical cancer. Tumor SUVmax/ADC ratio may predict pelvic nodal involvement.

scholarly journals Pelvic radiotherapy for cervical cancer affects importantly the reproducibility of cytological alterations evaluation

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Fernanda A. Lucena ◽  
Ricardo F. A. Costa ◽  
Maira D. Stein ◽  
Carlos E. M. C. Andrade ◽  
Geórgia F. Cintra ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pelvic Radiotherapy ◽  
Cytological Alterations

scholarly journals Association between the location of transposed ovary and ovarian dose in patients with cervical cancer treated with postoperative pelvic radiotherapy

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiao-juan Lv ◽  
Xiao-long Cheng ◽  
Ye-qiang Tu ◽  
Ding-ding Yan ◽  
Qiu Tang
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Adjuvant Radiotherapy ◽  
Iliac Crest ◽  
Ovarian Function ◽  
Pelvic Radiotherapy ◽  
Cutoff Value ◽  
Ovarian Transposition ◽  
Transverse Distance ◽  
Upper Boundary

Abstract Background and purpose How to protect the ovarian function during radiotherapy is uncertain. The purpose of this study was to explore the association between the location of the transposed ovary and the ovarian dose in patients with cervical cancer received radical hysterectomy, ovarian transposition, and postoperative pelvic radiotherapy. Methods A retrospective analysis was conducted of 150 young patients with cervical cancer who received radical hysterectomy, intraoperative ovarian transposition, and postoperative adjuvant radiotherapy in Zhejiang Cancer Hospital. Association between location of the transposed ovaries and ovarian dose was evaluated. The transposed position of ovaries with a satisfactory dose was explored using a receiver operator characteristic curve (ROC) analysis. Patients’ ovarian function was followed up 3 months and 1 year after radiotherapy. Results A total of 32/214 (15%) transposed ovaries were higher than the upper boundary of the planning target volume (PTV). The optimum cutoff value of > 1.12 cm above the iliac crest plane was significantly associated with ovaries above the upper PTV boundary. When the ovaries were below the upper boundary of PTV, the optimum cutoff value of transverse distance > 3.265 cm between the ovary and PTV was significantly associated with ovarian max dose (Dmax) ≤ 4Gy, and the optimum cutoff value of transverse distance > 2.391 cm was significantly associated with ovarian Dmax≤5Gy. A total of 77 patients had received complete follow-up, and 56 patients (72.7%) showed preserved ovarian function 1 year after radiotherapy, which was significantly increased compared with 3 months (44.2%) after radiotherapy. Conclusions The location of transposed ovaries in patients with cervical cancer is significantly correlated with ovarian dose in adjuvant radiotherapy. We recommend transposition of ovaries > 1.12 cm higher than the iliac crest plane to obtain ovarian location above PTV. When the transposed ovary is below the upper boundary of PTV, ovarian Dmax ≤4Gy may be obtained when the transverse distance between the ovary and PTV was > 3.265 cm, and the ovarian Dmax≤5Gy may be obtained when the transverse distance was > 2.391 cm.

scholarly journals 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

2020 ◽  
Vol 25 (11) ◽  
pp. 1977-1984
Author(s):  
Takeaki Kusada ◽  
Takafumi Toita ◽  
Takuro Ariga ◽  
Wataru Kudaka ◽  
Hitoshi Maemoto ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Treatment Time ◽  
Treatment Protocol ◽  
Japanese Patients ◽  
Oncologic Outcomes ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Tumor Diameter ◽  
Pelvic Radiotherapy ◽  
Definitive Radiotherapy

Abstract Background This prospective study investigated the feasibility, toxicity, and oncologic outcomes of definitive radiotherapy (RT) consisting of whole pelvic radiotherapy with no central shielding (noCS-WPRT) and CT-based intracavitary brachytherapy (ICBT) in Japanese patients with cervical cancer. Methods Patients with cervical cancer of FIGO stages IB1–IVA were eligible. The treatment protocol consisted of noCS-WPRT of 45 Gy in 25 fractions and CT-based high dose-rate ICBT of 15 or 20 Gy in 3 or 4 fractions prescribed at point A. The prescribed ICBT dose was decreased if the manual dwell time/position optimization failed to meet organs-at-risk constraints. Graphical optimization and additional interstitial needles were not applied. Results We enrolled 40 patients. FIGO stages were IB1: 11, IB2: 13, IIA2: 1, IIB: 11, IIIB: 3, and IVA: 1. Median (range) pretreatment tumor diameter was 47 (14–81) mm. Point A doses were decreased in 19 of 153 ICBT sessions (12%). The median follow-up duration was 33 months. The 2-year rates of pelvic control, local control (LC), and progression-free survival were 83%, 85%, and 75%, respectively. Pre-ICBT tumor diameter, high-risk clinical target volume (HR-CTV), total HR-CTV D90, and overall treatment time (OTT) significantly affected LC. Late adverse events (grade ≥ 3) were observed in 3 patients (2 in the bladder, 1 in the rectum). Conclusions Definitive RT consisting of noCS-WPRT and CT-based ICBT was feasible for Japanese patients with cervical cancer. To further improve LC, additional interstitial needles for patients with a large HR-CTV and shorter OTT should be considered.

scholarly journals Outcome and Subsequent Pregnancy after Fertility-Sparing Surgery of Early-Stage Cervical Cancers

2020 ◽  
Vol 17 (19) ◽  
pp. 7103
Author(s):  
Chia-Yi Lee ◽  
Yu-Li Chen ◽  
Ying-Cheng Chiang ◽  
Ching-Yu Cheng ◽  
Yen-Ling Lai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Live Birth ◽  
Early Stage ◽  
Medical Center ◽  
Subsequent Pregnancy ◽  
Definitive Treatment ◽  
Clinicopathologic Characteristics ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer

We aimed to investigate the outcomes and subsequent pregnancies of early-stage cervical cancer patients who received conservative fertility-sparing surgery. Women with early-stage cervical cancer who underwent conservative or fertility-sparing surgery in a tertiary medical center were reviewed from 2004 to 2017. Each patient’s clinicopathologic characteristics, adjuvant therapy, subsequent pregnancy, and outcome were recorded. There were 32 women recruited, including 12 stage IA1 patients and 20 stage IB1 patients. Twenty-two patients received conization/LEEP and the other 10 patients received radical trachelectomy. Two patients did not complete the definite treatment after fertility-sparing surgery. There were 11 women who had subsequent pregnancies and nine had at least one live birth. The live birth rate was 73.3% (11/15). We conclude that patients with early-stage cervical cancer who undergo fertility-sparing surgery can have a successful pregnancy and delivery. However, patients must receive a detailed consultation before surgery and undergo definitive treatment, if indicated, and regular postoperative surveillance.

A phase I study of sequential ipilimumab in the definitive treatment of node positive cervical cancer: GOG 9929.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5526-5526 ◽  
Author(s):  
Jyoti Mayadev ◽  
William E. Brady ◽  
Yvonne Gail Lin ◽  
Diane M Da Silva ◽  
Heather A. Lankes ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Phase I ◽  
Phase I Study ◽  
Immune Modulation ◽  
Disease Free Survival ◽  
Study Drug ◽  
Maximum Tolerated Dose ◽  
Definitive Treatment ◽  
Node Positive ◽  
Dismal Prognosis

5526 Background: The outcome of lymph node positive (LN) cervical cancer (CC) with chemoradiation (CRT) is dismal, especially with involved para-aortic nodes (PAN). The anti-CTLA-4 immune checkpoint inhibitor ipilimumab (ipi) holds promise. We report the safety, tolerability, and efficacy in this GOG phase I study examining sequential ipi after CRT for CC. Methods: Patients (pts) with LN CC were treated with 6 weekly doses of cisplatin (40 mg/m2) and extended field radiation (RT). 2-6 weeks after RT, if there was no progression of disease, sequential ipi was given at the following dose levels: dose level 1: 3mg/kg, level 2: 10mg/kg, and an expansion cohort of 10mg/kg. The primary endpoints (endpts) were the maximum tolerated dose (MTD), and dose-limiting toxicities (DLT) of adjuvant ipi. Secondary endpt included the 1-yr disease free survival (DFS). Translational endpts included the effect of CRT on enumeration and subsets of T-cells, and CTLA4, PD-1 and ICOS expression. Results: 34 pts were enrolled, and 19 pts are evaluable for the endpts: 14 pts went off study to reasons unrelated to the study drug, 1 pt continues in her DLT evaluable period. Of the evaluable pts, all had pelvic LN, with 25% PAN. All pts completed CRT, 90% had 4 cycles of ipi, and the other 10% had 2 cycles of ipi. The ipi MTD was 10 mg/kg. There were 3 pts (16%) with acute grade 3 toxicity (lipase, ↓ANC, rash) which self-resolved. Most of the acute toxicities were grade 1-2 GI distress, rash, endocrinopathies. There were no minor or major RT quality deviations. With a median follow up of 12 months, there were no major late toxicities reported, with a 1-year DFS of 74%. There was no difference in CD4+- and CD8+- T cell levels nor CTLA-4 expression with sequential ipi. CRT itself increased ICOS and PD-1 expression. Conclusions: This study is the first to describe the safety of immunotherapy sequencing with definitive CRT in CC. Our data suggests that immunotherapy is tolerable and shows possible activity in this population with a historical dismal prognosis with standard therapy. CRT increased ICOS and PD-1 expression which was sustained with ipi, illustrative of immune modulation targets for future clinical trials and radioimmunotherapy combinations. Clinical trial information: NCT01711515.

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