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Original research
Long-term outcomes of intensity-modulated radiation therapy (IMRT) and high dose rate brachytherapy as adjuvant therapy after radical hysterectomy for cervical cancer
  1. Jessika Contreras1,
  2. Amar Srivastava2,
  3. Anupama Chundury3,
  4. Julie K Schwarz2,
  5. Stephanie Markovina2,
  6. Premal H Thaker4,
  7. L Stewart Massad4,
  8. David G Mutch4,
  9. Matthew A Powell4,
  10. Perry W Grigsby2 and
  11. Alexander J Lin2
  1. 1Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
  2. 2Radiation Oncology, Washington University School of Medicine, St Louis, Missouri, USA
  3. 3Radiation Oncology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey, USA
  4. 4Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to Dr Alexander J Lin, Radiation Oncology, Washington University in Saint Louis, St Louis, MO 63110, USA; alexanderlin{at}wustl.edu

Abstract

Objective Compared with 3D-planned pelvic radiation, intensity-modulated radiation therapy (IMRT) has been shown to reduce acute toxicity in cervical cancer patients after radical hysterectomy. This study evaluated late toxicity and patterns of failure after post-operative pelvic IMRT interdigitated weekly with high dose rate brachytherapy.

Methods This retrospective study included 53 cervical cancer patients treated between January 2006 and August 2019 with radical hysterectomy, lymphadenectomy, and post-operative IMRT and high dose rate brachytherapy. The decision to include chemotherapy was made by the treating gynecologic oncologist based on patient-specific criteria including positive pelvic lymph nodes, positive surgical margins, or positive parametrial invasion. The actuarial rates of genitourinary and gastrointestinal toxicity, vaginal cuff/regional nodal/distant failure, and overall survival were calculated using the Kaplan–Meier method.

Results Median follow-up was 70 months (range 5.4–148) months and age at diagnosis was 47 (range 24–73) years. The 2018 International Federation of Gynecology and Obstetrics (FIGO) clinical stages were IB1 (n=19), IB2 (n=7), IIB (n=7), IIIC1 (n=19), and IIIC2 (n=1). Median radiation dose delivered in 160 cGy daily fractions was 5120 (range 4640–5120) cGy. Median brachytherapy dose prescribed to the vaginal surface delivered in six weekly fractions was 2400 (range 1200–4800) cGy. Concurrent chemotherapy was delivered in 35 (66%) patients. There were no acute grade >3 genitourinary or gastrointestinal toxicities. Late grade >3 occurred in two (3.8%) patients, including a small bowel obstruction and a ureteral stricture. The 5-year actuarial rate for gastrointestinal or genitourinary toxicity was 1.9%. There were no vaginal cuff recurrences. The 5-year actuarial rates for regional nodal failure, distant failure outside the radiation field, any failure, and overall survival were 11%, 11%, 14%, and 85%, respectively.

Conclusions Post-operative IMRT with high dose rate brachytherapy for patients with cervical cancer is associated with excellent outcomes and limited rates of radiation-related non-hematologic toxicity.

  • cervical cancer
  • radiotherapy, intensity-modulated
  • brachytherapy
  • postoperative complications
  • neoplasm recurrence, local

https://doi.org/10.1136/ijgc-2020-001412

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    Footnotes

    • Twitter @zander_lin

    • Contributors JC, PWG, and AJL designed the study. JC, AS, AC, PWG, and AJL collected data. AJL did the statistical analysis. JC, PWG, and AJL drafted the manuscript. All authors reviewed and edited the submitted manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data are prospectively maintained in an institutional IRB-approved database.