Introduction Current consensus guidelines for definitive cervical cancer intensity modulated radiation therapy (IMRT) recommend inclusion of the entire uterus within the clinical target volume, however this is controversial. We aimed to evaluate outcomes of patients with cervical cancer who were treated with less than whole uterus irradiation.

Methods We identified 112 patients with FIGO Stage IB-IVA cervical cancer treated definitively with concurrent chemoradiation, including IMRT and brachytherapy, from 2010 to 2022 at a single institution where the practice was to include the gross cervix tumor plus additional margin. Local, regional, and distant recurrences were analyzed using competing risk methods, and a Wilcoxon rank sum test was performed to assess differences in bowel dose based on the proportion of the uterus included in the planning target volume (PTV).

Results With a median follow up time of 30.1 months, the 2-year cumulative incidence of local recurrence was 5%. Compared with patients who had ≥90% of the uterus included in the PTV (n=35), patients who had <90% (n=77) of the uterus included in the PTV had significantly lower bowel D200cc (p<0.01). The cumulative incidence of locoregional failure was not significantly different between the two groups. Only one patient experienced an isolated local failure and their PTV included ≥90% of the uterus.

Conclusion/Implications Including less than the whole uterus for definitive cervix cancer IMRT does not compromise locoregional control. Less than whole uterus irradiation should be considered for cervix cancer patients to decrease bowel dose and treatment-related toxicity.