Introduction/Background Concomitant chemoradiation therapy (CRT) that includes both external beam radiotherapy (EBRT) and brachytherapy (BT) is the current standard of care in treatment of locally advanced cervical cancer (LACC). Volumetric Modulated Arc technology provides potential benefits allowing for dose escalation and decreased toxicities. This non-BT approach offers improved accuracy and no geographical miss due to adaptive radiotherapy, but oncologic outcomes still need to be evaluated.
Methodology Patients with LACC (stages 1B3-IVA) who underwent CRT using EBRT and simultaneous integrated boost at our institution were evaluated prospectively from May 2015 till April 2019. All were initially evaluated by a gynecologic oncologist then with MRI and 18FDG-PET/CT. Histology was confirmed by an expert pathologist. Interval CT were performed during treatment, pelvic exams with cytology every 3 months and PET/CT at 3 and 12 months after completion of treatment. Oncologic outcomes and toxicities were assessed.
Results 21 patients were analyzed: median age was 54 years (30–76), 19 patients had squamous cell histology, 2 had adenocarcinoma. Median follow-up was 26 months (3–44), average dose to the gross tumor volume was 90.2 Gy (79.5–96.6), 79.8 Gy to all PET/MRI positive nodes (63.0–89.7) and 56.3 Gy (45–67.6) to all elective nodes. No patents received BT, all but three received chemotherapy. 3-year local control was 100%, PFS 90.4% and OS 100%. There were only two recurrences: a skull lesion 18 months following CRT in a patient with mesonephric adenocarcinoma and a transposed ovary metastases 15 months after CRT in the other. No grade III–IV toxicities seen, only one patient (4.7%) had late rectal grade II toxicity.
Conclusion Non-brachytherapy CRT for LACC is feasible. It allows for a significant dose escalation thus provides better local control and likely increases PFS and OS at no risk of serious toxicity. Randomised studies comparing this approach to the current standard of care are needed.
Disclosure Nothing to disclose.
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