Extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy for cervical cancer with para-aortic lymph nodes metastasis

2018 ◽  
Vol 49 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Xiaoliang Liu ◽  
Weiping Wang ◽  
Qingyu Meng ◽  
Fuquang Zhang ◽  
Ke Hu
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Field Intensity ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Intensity Modulated ◽  
Genitourinary Toxicity ◽  
Extended Field ◽  
Grade 3

Abstract Objective This study was conducted to evaluate the efficacy and toxicity of extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy in patients with cervical cancer with positive para-aortic lymph nodes (PALN). Methods From September 2007 to December 2014, a total of 59 patients who had cervical cancer with para-aortic lymph node metastasis were treated with concurrent chemoradiotherapy at our institution. A dose of 45–50.4 Gy in 25–28 fractions with extended-field intensity-modulated radiation therapy was prescribed to planning target volume, and a dose of 30–36 Gy in 5–6 fractions was prescribed to Point A with high-dose-rate brachytherapy. A concurrent first-line cisplatin-based chemotherapy regimen was used. Results The median duration of follow-up was 32.1 months (range, 3.2–103.7 months). The 2- and 3-year overall survival, disease-free survival and local control rates were 69.0 and 52.8%, 45.0 and 41.3% and 83.4 and 81.0%, respectively. Distant metastasis was the major pattern of treatment failure, which occurred in 26 patients (44.1%). The incidence of Grade 3 or greater acute hematologic, gastrointestinal and genitourinary toxicity was 50.9, 1.7 and 3.4%, respectively. Only one patient had both Grade 3 late gastrointestinal and genitourinary toxicity. Conclusions The study found that extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy was safe and effective in patients who had cervical cancer with positive PALN.

Low-Dose, Prophylactic, Extended-Field, Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin for Patients With Stage IB2-IIIB Cervical Cancer, Positive Pelvic Lymph Nodes, and Negative Para-aortic Lymph Nodes

2014 ◽  
Vol 24 (5) ◽  
pp. 901-907 ◽  
Author(s):  
Ji-An Liang ◽  
Shang-Wen Chen ◽  
Yao-Ching Hung ◽  
Lian-Shung Yeh ◽  
Wei-Chun Chang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Field Intensity ◽  
Low Dose ◽  
Intensity Modulated Radiotherapy ◽  
Free Survival ◽  
Intensity Modulated ◽  
Extended Field ◽  
Grade 3 ◽  
Weekly Cisplatin

ObjectiveThe objective of this study was to assess prospectively the clinical outcomes of low-dose prophylactic extended-field, intensity-modulated radiotherapy (IMRT) plus concurrent weekly cisplatin for patients with stage IB2-IIIB cervical cancer, positive pelvic lymph nodes (PLNs), and negative para-aortic lymph nodes (PALNs).MethodsThirty-two patients with stage IB2-IIIB cervical cancer with positive PLN and negative PALN were included prospectively. All lymph nodes were assessed with positron emission tomography. The PALN field, including lymphatics from the superior border of L1 to the L4-L5 interphase, was irradiated concurrently with pelvic IMRT with a prescribed dose of 40 Gy in 25 fractions. Chemotherapy consisted of cisplatin delivered weekly at a dose of 40 mg/m2. Using historical controls treated with pelvic radiotherapy, the survival curves were compared to assess the difference between the 2 treatment periods.ResultsThirty-one patients completed the allocated extended-field IMRT, and all finished the planned pelvic IMRT and brachytherapy. Acute ≥ grade 3 gastrointestinal, genitourinary, and hematologic toxicities were seen in 2, 1, and 18 patients, respectively. During a median follow-up of 33 months, 5 patients developed out-field distant recurrences. One patient had a late grade 3 gastrointestinal complication, and 1 patient had genitourinary toxicity. The 3-year actuarial overall survival, disease-free survival, and distant metastasis–free survival for the study cohort and historic controls were 87% versus 62% (P = 0.02), 82% versus 54% (P = 0.02), and 79% versus 57% (P = 0.01), respectively.ConclusionsExtended-field IMRT of 40 Gy to the PALN plus concurrent cisplatin can effectively eradicate subclinical disease at the PALN and improve the outcome for patients with PLN-positive stage IB2-IIIB cervical cancer.

scholarly journals Long-Term Toxicity and Efficacy of Intensity-Modulated Radiation Therapy in Cervical Cancers: Experience of a Cancer Hospital in Pakistan

2020 ◽  
pp. 1639-1646
Author(s):  
Muhammad Atif Mansha ◽  
Tabinda Sadaf ◽  
Asmara Waheed ◽  
Amna Munawar ◽  
Asma Rashid ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Tumor Size ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Grade 3

PURPOSE To report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer. METHODS AND MATERIALS Between January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated. RESULTS A total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery ( P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates ( P < .05). CONCLUSION IMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.

Intensity-modulated radiation therapy with concurrent chemotherapy for head and neck squamous cell carcinomas: Toxicity assessment

2021 ◽  
Author(s):  
Nguyen Tuong Pham
Keyword(s):  
Radiation Therapy ◽  
Squamous Cell ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Squamous Cell Carcinomas ◽  
Chemoradiation Therapy ◽  
Intensity Modulated ◽  
Grade 3 ◽  
Concurrent Chemoradiation Therapy

Background: Intensity-modulated radiotherapy with concurrent chemotherapy attempt to maintain efficiency while limiting toxicity in the treatment of neck squamous cell carcinomas. Side effects of the therapy are both challenge during treatment such as treatment delay, increasing financial and hospitalization rate and also cause early and late toxicities, affects to patient performances and treatment outcomes. We aimed to assess acute and late toxicity in patients with head and neck squamous cell carcinoma (HNSCC) managed with concurrent chemoradiation therapy using intensity modulated radiation therapy (IMRT) technique. Methods: A prospective descriptive study of 120 patients suffering from non-metastatic HNSCC received Intensity-modulated radiotherapy concurrently with four to six cycles of cisplatin (30mg/m2/day/ weekly) from May 2017 to 2018 at Hue Central Hospital (Vietnam). The dose to the primary tumour and cervical lymph nodes totally taken was 70 Gy. Toxicities were gradedbased on the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG). Results: Acute toxicities were mainly at grade 1 with oral mucositis, dermatitis and nausea/vomiting. For late toxicities, grade 3 xerostomia accountings for 5.8%. Neck fibrosis and trismus were not at grade 3 to grade 4, grade 1 mandibular bone necrosis (3.4%) was found in 3 patients. Conclusions: Concurrent chemoradiation therapy with IMRT demonstrated a well-tolerated regime with manageable toxicities.

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