Late Toxicity After Adjuvant Conventional Radiation Versus Image-Guided Intensity-Modulated Radiotherapy for Cervical Cancer (PARCER): A Randomized Controlled Trial

2021 ◽  
pp. JCO.20.02530
Author(s):  
Supriya Chopra ◽  
Sudeep Gupta ◽  
Sadhana Kannan ◽  
Tapas Dora ◽  
Reena Engineer ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Late Toxicity ◽  
Free Survival ◽  
Image Guided ◽  
Intensity Modulated ◽  
Gi Toxicity ◽  
Disease Free ◽  
Pelvic Relapse ◽  
3D Crt

PURPOSE Postoperative Adjuvant Radiation in Cervical Cancer (PARCER), a phase III randomized trial, compared late toxicity after image-guided intensity-modulated radiotherapy (IG-IMRT) with three-dimensional conformal radiation therapy (3D-CRT) in women with cervical cancer undergoing postoperative radiation. METHODS Patients were randomly assigned to receive either IG-IMRT or 3D-CRT after stratification for the type of hysterectomy and use of concurrent chemotherapy. The primary end point was 3-year grade ≥ 2 late GI toxicity assessed using Common Toxicity Criteria for Adverse Events v 3.0 and estimated using time-to-event, intention-to-treat analysis, with a study level type I error of 0.05 and a nominal α of .047 after accounting for one interim analysis. Secondary end points included acute toxicity, health-related quality of life, and pelvic relapse-free, disease-free, and overall survival. RESULTS Between 2011 and 2019, 300 patients were randomly assigned (IG-IMRT 151 and 3D-CRT 149). At a median follow-up of 46 (interquartile range 20-72) months, the 3-year cumulative incidence of grade ≥ 2 late GI toxicity in the IG-IMRT and 3D-CRT arms were 21.1% versus 42.4% (hazard ratio [HR] 0.46; 95% CI, 0.29 to 0.73; P < .001). The cumulative incidence of grade ≥ 2 any late toxicity was 28.1% versus 48.9% (HR 0.50; 95% CI, 0.33 to 0.76; P < .001), respectively. Patients reported reduced diarrhea ( P = .04), improved appetite ( P = .008), and lesser bowel symptoms ( P = .002) with IG-IMRT. However, no difference was observed in the time by treatment interaction. The 3-year pelvic relapse-free survival and disease-free survival in the IG-IMRT versus the 3D-CRT arm were 81.8% versus 84% (HR 1.17; 95% CI, 0.68 to 1.99; P = .55) and 76.9% versus 81.2% (HR 1.03; 95% CI, 0.62 to 1.71; P = .89), respectively. CONCLUSION IG-IMRT results in reduced toxicity with no difference in disease outcomes.

scholarly journals Clinical analysis of conformal and intensity-modulated radiotherapy in patients with recurrent ovarian cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hua Yang ◽  
Kaishuo Zhang ◽  
Zi Liu ◽  
Tao Wang ◽  
Fan Shi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Recurrent Ovarian Cancer ◽  
Hematological Toxicity ◽  
Free Survival ◽  
Intensity Modulated ◽  
Gi Toxicity ◽  
Grade 3 ◽  
Radiotherapy Dose ◽  
3D Crt

Abstract We aimed to provide evidence for radiotherapy treatment regimens in patients with clinically recurrent ovarian cancer. We analyzed the survival and prognostic factors in 43 patients who were treated for recurrent ovarian cancer at 58 tumor sites using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) during January 2006–December 2017. t years 1, 2, and 3, overall survival (OS) rate was 82.4%, 68.4%, and 57.9%; local control (LC) rate was 100%, 100% and 80%; recurrence free survival (RFS) rate was 86.8%, 66.6%, and 61.1%; and disease-free survival (DFS) rate was 79.7%, 56.7%, and 46.8%, respectively. The radiotherapy technique was determined to be an independent prognostic factor for survival; the survival rate of patients was significantly improved with IMRT compared to 3D-CRT (P = 0.035). Radiotherapy dose was an independent prognostic factor; survival rate improved when patients were treated with a radiation dose ≥ 60 Gy as compared to < 60 Gy (P = 0.046). Elective nodal prophylactic radiation therapy (ENRT) did not lead to a significant improvement in survival when compared to involved-field radiation therapy (IFRT). The toxicities of 3D-CRT and IMRT were tolerable. One patient (2.3%) had grade 3 acute gastrointestinal (GI) toxicity, 2 (4.6%) grade 3 late GI toxicity, 5 (11.6%) grade 3 hematological toxicity, and 2 (4.6%) had grade 4 hematological toxicity. IMRT improved LC and OS in patients with recurrent ovarian cancer after surgery and multiple chemotherapy; toxicities were tolerable. The IMRT technique and radiotherapy dose of ≥ 60 Gy had independent prognostic significance for the survival of such patients.

Outcomes for Patients With Cervical Cancer Treated With Extended-Field Intensity-Modulated Radiation Therapy and Concurrent Cisplatin

2013 ◽  
Vol 23 (1) ◽  
pp. 119-125 ◽  
Author(s):  
Lindsay G. Jensen ◽  
Michael D. Hasselle ◽  
Brent S. Rose ◽  
Sameer K. Nath ◽  
Yasmin Hasan ◽  
...  
Keyword(s):  
Field Intensity ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Late Toxicity ◽  
Free Survival ◽  
Intensity Modulated ◽  
Distant Failure ◽  
Extended Field ◽  
Competing Mortality ◽  
Disease Free

ObjectiveTo evaluate disease outcomes and toxicity in patients with cervical cancer treated with extended-field intensity-modulated radiotherapy.Materials and MethodsWe included all patients treated with extended-field intensity-modulated radiotherapy and concurrent weekly cisplatin from 2003 to 2010 at 2 institutions. Overall survival and disease-free survival were estimated using Kaplan-Meier method. Locoregional failure (LRF), distant failure, and competing mortality were calculated using cumulative incidence functions. Acute and late toxicity were graded using Common Terminology Criteria for Adverse Events (CTCAE) and Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively.ResultsThe study included 21 patients, 14 and 20 of which had positive para-aortic and pelvic nodes, respectively. The median follow-up was 22 months. Eighteen-month overall survival and disease-free survival were 59.7% (95% confidence interval [CI], 41.2%–86.4%) and 42.9% (95% CI, 26.2%–70.2%). Eighteen-month cumulative incidences of LRF, distant failure, and competing mortality were 9.5% (95% CI, 1.5–26.8%), 42.9% (95% CI, 21.3–62.9%), and 4.8% (95% CI, 0.3–20.2%), respectively. Eighteen-month cumulative incidences of late grade 3 or higher-grade genitourinary and gastrointestinal toxicity were 4.8% (95% CI, 0.2%–20.3%) and 0%, respectively.ConclusionsIntensity-modulated extended-field radiotherapy was associated with low rates of late toxicity and LRF. High rates of distant failure indicate that this group of patients could benefit from intensified systemic therapy.

Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer

2019 ◽  
Vol 30 (2) ◽  
pp. 181-186 ◽  
Author(s):  
Benoit Bataille ◽  
Alexandre Escande ◽  
Florence Le Tinier ◽  
Audrey Parent ◽  
Emilie Bogart ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Tumor Size ◽  
Early Stage ◽  
Disease Free Survival ◽  
Late Toxicity ◽  
Free Survival ◽  
Overweight Status ◽  
Early Stage Cervical Cancer ◽  
Early Cervical Cancer ◽  
Disease Free

ObjectiveThe standard of care for early cervical cancer is radical hysterectomy; however, consideration of pre-operative brachytherapy has been explored. We report our experience using pre-operative brachytherapy plus Wertheim-type hysterectomy to treat early stage cervical cancer.MethodsThis single-center study evaluated consecutive patients with histologically proven node-negative early stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIB) that was treated using pre-operative brachytherapy and hysterectomy. Pre-brachytherapy staging was performed using magnetic resonance imaging (MRI) and pelvic lymph node assessment was performed using lymphadenectomy. The tumor and cervical tissues were treated using brachytherapy (total dose 60 Gy) followed by Wertheim-type hysterectomy. The study included patients from January 2000 to December 2013.ResultsA total of 80 patients completed a median follow-up of 6.7 years (range 5.4–8.5). The surgical specimens revealed a pathological complete response for 61 patients (76%). Patients with incomplete responses generally had less than 1 cm residual tumor at the cervix, and only one patient had lymphovascular space involvement. The estimated 5-year rates were 88% for overall survival (95% CI 78% to 94%) and 82% for disease-free survival (95% CI 71% to 89%). Toxicities were generally mild-to-moderate, including 26 cases (33%) of grade 2 late toxicity and 10 cases (13%) of grade 3 late toxicity. Univariate analyses revealed that poor disease-free survival was associated with overweight status (≥25 kg/m2, HR 3.05, 95% CI 1.20 to 7.76, p=0.019) and MRI tumor size >3 cm (HR 3.05, 95% CI 1.23 to 7.51, p=0.016).ConclusionsPre-operative brachytherapy followed by Wertheim-type hysterectomy may be safe and effective for early stage cervical cancer, although poorer outcomes were associated with overweight status and MRI tumor size >3 cm.

Completion Surgery After Intensity-Modulated Arc Therapy in the Treatment of Locally Advanced Cervical Cancer: Feasibility, Surgical Outcome, and Oncologic Results

2013 ◽  
Vol 23 (5) ◽  
pp. 877-883 ◽  
Author(s):  
Philippe Tummers ◽  
Amin Makar ◽  
Katrien Vandecasteele ◽  
Gert De Meerleer ◽  
Hannelore Denys ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Cervical Cancer ◽  
Bulky Disease ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer ◽  
Intensity Modulated ◽  
Arc Therapy ◽  
Disease Free

IntroductionSince the addition of chemotherapy to radiotherapy, the survival rates of locally advanced cervical cancer (LACC) have improved but are still disappointing. Therefore, the idea of surgery after chemoradiation in case of LACC or bulky disease was adopted. One of the concerns regarding surgery following chemoradiotherapy is surgery-related morbidity.AimThe objectives of this study were to investigate the feasibility of surgery after advanced radiotherapy techniques such as intensity-modulated arc therapy (IMAT) and to describe the morbidity.MethodsThis was a prospective study of primary inoperable LACC patients primary treated with IMAT, in most cases combined with weekly cisplatin. Then the resectability was reevaluated. If resectable patients were treated with Wertheim type 2 surgery ± pelvic lymphadenectomy (on positron emission tomography–computed tomography indication). If tumor is not resectable, patients were treated with brachytherapy.ResultsSince 2006, 41 consecutive patients were included. After neoadjuvant IMAT, 34 were considered resectable and underwent surgery, whereas 7 proceeded with brachytherapy. The operative mortality rate was nil. There were no major perioperative complications. No ureter, bladder, or bowel injuries occurred. No postoperative urinary/digestive fistulae or stenoses were noted. Eleven patients had postoperatively urinary retention problems. At the time of discharge, 5 patients still needed self-catheterization. All problems resolved within 3 months. In 4 cases, we saw significant lymphoceles. In all patients intended to treat, overall survival and disease-free survival at 3 years were 63% and 74%. In the Wertheim group, overall survival and disease-free survival at 3 years were 81% and 91%.ConclusionsCompleting surgery after chemoradiation therapy (with IMAT) for LACC or bulky disease is feasible, and complication rates are comparable with those of primary surgery for cervical cancer.

scholarly journals Impact on Late Toxicity of using Transabdominal Ultrasound for Prostate Cancer Patients Treated with Intensity Modulated Radiotherapy

2005 ◽  
Vol 4 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Ashesh B. Jani ◽  
John Gratzle ◽  
Emil Muresan ◽  
Mary K. Martel
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
External Beam Radiotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Late Toxicity ◽  
Institutional Setting ◽  
Regression Analyses ◽  
Intensity Modulated ◽  
Gu Toxicity ◽  
Gi Toxicity

An analysis of the effects of using the B-mode ultrasound Acquisition and Targeting (BAT) system for positioning of prostate cancer patients receiving external beam radiotherapy (EBRT) on late gastrointestinal (GI) and genitourinary (GU) toxicity is provided. The records of 49 consecutive patients treated using the BAT were reviewed; additionally, a comparison (No-BAT) group treated in a similar manner was identified, consisting of 49 patients treated immediately prior to this BAT group. There were no other fundamental differences between the two groups. The daily BAT movements were charted and late toxicity was scored for all patients using established toxicity scales. The results demonstrated similar GU toxicity rates between the two groups, but slightly lower rates of GI toxicity in the BAT group vs. the No-BAT group. However, regression analyses revealed that no factors, including BAT use, were significantly correlated with late GI or GU toxicity. Further efforts, perhaps better undertaken in a multi-institutional setting, are needed to determine whether BAT use can significantly reduce late GI toxicity.

scholarly journals Concurrent Definitive Chemoradiation Incorporating Intensity-Modulated Radiotherapy Followed by Adjuvant Chemotherapy in High Risk Locally Advanced Cervical Squamous Cancer: A Phase Ⅱ Study.

2021 ◽  
Author(s):  
Gong-yi ZHANG ◽  
ZHANG Rong ◽  
Ping BAI ◽  
Shu-min LI ◽  
Yuan-yuan ZHANG ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Advanced Cervical Cancer ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer ◽  
Intensity Modulated ◽  
Grade 3

Abstract Background Although the prognosis of locally advanced cervical cancer has improved dramatically, survival for those with stage ⅢB-ⅣA disease or lymph nodes metastasis remains poor. It is believed that the incorporation of intensity-modulated radiotherapy into the treatment of cervical cancer might yield an improved loco-regional control, whereas more cycles of more potent chemotherapy after the completion of concurrent chemotherapy was associated with a diminished distant metastasis. We therefore initiated a non-randomized prospective phaseⅡ study to evaluate the feasibility of incorporating both these two treatment modality into the treatment of high risk locally advanced cervical cancer. Objectives to determine whether the incorporation of intensity-modulated radiotherapy and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment policy for patients with high risk locally advanced cervical cancer might improve their oncologic outcomes. Study Design: Patients were enrolled if they had biopsy proven stage ⅢA-ⅣA squamous cervical cancer or stage ⅡB disease with metastatic regional nodes. Intensity-modulated radiotherapy was delivered with dynamic multi-leaf collimators using 6MV photon beams. Prescription for PTV ranged from 45.0 ~ 50.0Gy at 1.8Gy ~ 2.0Gy/fraction in 25 fractions. Enlarged nodes were contoured separately and PTV-nodes were boosted simultaneously to a total dose of 50.0–65 Gy at 2.0- 2.6Gy/fraction in 25 fractions. A total dose of 28 ~ 35Gy high-dose- rate brachytherapy was prescribed to point A in 4 ~ 5 weekly fractions using an iridium- 192 source. Concurrent weekly intravenous cisplatin at 30mg/m2 was initiated on the first day of radiotherapy for over 1-hour during external-beam radiotherapy. Adjuvant chemotherapy was scheduled within 4 weeks after the completion of concurrent chemo-radiotherapy and repeated 3 weeks later. Paclitaxel 150 mg/m2 was given as a 3-hour infusion on day1, followed by cisplatin 35 mg/m2 with 1-hour infusion on day1-2 (70 mg/m2 in total). Results Fifty patients achieved complete response 4 weeks after the completion of the treatment protocol, whereas 2 patients had persistent disease. After a median follow-up period of 66 months, loco-regional (including 2 persistent disease), distant, and synchronous treatment failure occurred in 4 ,5, and 1, respectively. The 5-year disease-free survival, loco-regional recurrence-free survival, distant-metastasis recurrence-free survival was 80.5%, 90.3%, and 88.0%, respectively. Four of the patients died of the disease, and the 5-year overall survival was 92.1%. Most of the toxicities reported during concurrent chemo-radiotherapy were mild and transient. The occurrence of hematological toxicities elevated mildly during adjuvant chemotherapy, as 32% (16/50) and 4% (2/50) patients experienced grade 3–4 leukopenia and thrombocytopenia, respectively. Grade 3–4 late toxicities were reported in 3 patients. Conclusions The incorporation of intensity-modulated radiotherapy and adjuvant paclitaxel plus cisplatin chemotherapy were highly effective and well-tolerated in the treatment of high-risk locally advanced cervical cancer. The former yields an improved loco-regional control, whereas distant metastases could be effectively eradicated with mild toxicities when adjuvant regimen was prescribed.

scholarly journals Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhouying Peng ◽  
Yumin Wang ◽  
Yaxuan Wang ◽  
Ruohao Fan ◽  
Kelei Gao ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Meta Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Intensity Modulated ◽  
T Stage ◽  
Recurrent Nasopharyngeal Carcinoma ◽  
Disease Free

BackgroundThis meta-analysis aimed to compare the efficacy of intensity-modulated radiotherapy (IMRT) and endoscopic surgery (ES) for high T-stage recurrent nasopharyngeal carcinoma (NPC).MethodsRelevant studies were retrieved in six databases from 02/28,2011 to 02/28,2021. The 2-year, 3-year, 5-year overall survival (OS) rates and 2-year disease-free survival (DFS) rates were calculated to compare the survival outcomes of the two treatments of IMRT and ES. Combined odds ratios (ORs) and 95% confidence interval (C Is) were measured as effect size on the association between high T-stage and 5-year OS rates.ResultsA total of 23 publications involving 2,578 patients with recurrent NPC were included in this study. Of these, 1611 patients with recurrent rT3-4 NPC were treated with ES and IMRT in 358 and 1,253 patients, respectively. The combined 2-year OS and 5-year OS rates for the two treatments were summarized separately, and the 2-year OS and 5-year OS rate for ES were 64% and 52%, respectively. The 2-year OS and 5-year OS rate for IMRT were 65% and 31%, respectively. The combined 2-year DFS rates of IMRT and ES were 60% and 50%, respectively. Combined ORs and 95% confidence intervals for 5-year survival suggest that ES may improve survival in recurrent NPC with rT3-4. In terms of complications, ES in the treatment of high T-stage recurrent NPC is potentially associated with fewer complications.ConclusionsThe results of our study suggest that ES for rT3-4 may be a better treatment than IMRT, but the conclusion still needs to be sought by designing more studies.

scholarly journals EP-1477 Image-guided Intensity Modulated Radiotherapy in cervical cancer: organ motion and geograpical miss

2019 ◽  
Vol 133 ◽  
pp. S801
Author(s):  
P. Ferrazza ◽  
A. Delana ◽  
L. Purpura ◽  
E. Magri ◽  
L. Bandera ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Organ Motion ◽  
Image Guided ◽  
Intensity Modulated

Correlation between c-erb-B2 overexpression with disease-free survival and rate of pelvic relapse in patients with advanced cervical cancer treated with chemo-radiotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16004-16004
Author(s):  
J. Pérez-Regadera ◽  
A. Sánchez-Muñoz ◽  
J. De-la-Cruz ◽  
C. Ballestín ◽  
D. Lora ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Immunohistochemical Method ◽  
Advanced Cervical Cancer ◽  
Pelvic Radiotherapy ◽  
Free Survival ◽  
The Impact ◽  
Disease Free ◽  
Pelvic Relapse

16004 Aims: To determine the impact of the c-erb-B2 overexpression receptor on pelvic relapse and on disease-free survival (DFS) in patients with advanced cervical cancer receiving concurrent chemo-radiotherapy. Methods: One hundred thirty six patients with advanced cervical cancer (stage: 12 IB2-IIA, 34 IIB, 71 IIIB, 19 IVA); histology: 86 epidermoid and 14 adenocarcinoma) were analyzed to detect c-erbB-2 level using an immunohistochemical method (Herceptest Dako). Cases c-erbB-2 (+3) were considered positive. All patients received pelvic radiotherapy, brachitherapy and concurrent chemotherapy with two schedules: 48 patients with tegafur (800 mg/day via oral) and 88 with tegafur (same doses) plus five cycles of weekly cisplatin 40 mg/m2/week iv. Results: Of the 136 biopsies, 32 (23.5%) were c- erbB-2 positive. The disease free survival to 3 and 5 years of the patients were 61% and 58% for c-erb-B2 negative and 36% and 36% for c-erb- B2 positive (p=0.02), respectively.We divided our patients in four groups: c-erb-B2 positive treated with cisplatin; c-erb-B2 positive without cisplatin, c-erb-b2 negative treated with cisplatin and c-erb-b2 negative without cisplatin. The group of patients with c-erb-B2 overexpression that did not received platinum treatment had a higher rate of pelvis relapse (p<0.0001) and with a decreased DFS (p=0.0014). Conclusions: c-erbB-2 overexpression may imply a poor prognosis for patients with advanced cervix cancer, especially if they did not receive concurrent radiochemotherapy with cisplatin. No significant financial relationships to disclose.

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