Introduction/Background*The high-dose-rate intra-cavity brachytherapy (HDR-ICBT) has an important and essential role for radiation therapy for uterus cervical cancer ad rectal dose reduction is critical for determining the radiation dose for HDR-ICBT. In Asia, standard external beam radiation therapy combines whole pelvic radiation therapy (WPRT) and sequential WPRT with central shielding (WPRT-CS) for rectal dose reduction prior to HDR-ICBT. This study aimed to evaluate the treatment outcome and tolerance of the combination treatment strategy.
Methodology Forty-six cervical cancer patients treated from 8/2011 to 9/2020 were included in this retrospective analysis. All patients received combination therapy of HDR-ICBT and EBRT which is consisted of WPRT and WPRT-CS using IMRT/TomoTherapy.
Result(s)*Primary tumor stages (FIGO) were distributed as follows: IB: 6, IIA: 4, IIB: 12, IIIA: 1, IIIB: 3, IIIC1:17, IIIC2:3 (with Para-aortic lymph node metastasis), pelvic lymph node metastasis(N+): 21. Forty patients had squamous cell carcinoma (SCC) and the remaining six had adenocarcinoma. The median age of patients was 65.5 (range, 30–91) years. All patients completed treatment, and the median dose of WPRT and WPRT-CS was 36 (range, 20–43.2) and 14.4 (range, 7.2–28) Gy, respectively. Median HDR-ICBT dose/fractions to Point A was 25 Gy/5 Fr (range, 15–30 Gy/3–5 Fr). Thirty-five had weekly cisplatin concomitant with RT.
Median follow-up was 43.5 (range, 4–122) months, and 5-year local control, disease-free survival, and overall survival rates (OS) were 95.6%, 84.0%, and 83.1%, respectively. There was only two local failure and seven patients experienced distant metastasis (4 lung metastasis and 3 para-aortic metastasis). Four of seven patients with distant metastasis received salvage therapy and the disease got controlled. One patient who controlled cervical cancer, developed primary lung cancer and died of that. No acute or late ≥ Grade 3 radiation-induced genitourinary or gastrointestinal toxicities were observed.
Conclusion*In the present study, the combination of IMRT consisting of WPRT and WPRT-CS using TomoTherapy and HDR-ICBT show comparatively long-term great local disease control. and tolerance rates for cervical cancer patients. This combination strategy is considered one of the effective and safe treatment options for cervical cancer.
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