ESTRO 2022

Session Item

Monday

May 09

14:15 - 15:15

Mini-Oral Theatre 2

22: AI, big data, automation

Co-Chair: Eugenia Vlaskou Badra, Switzerland;

Chair: Stephanie Tanadini-Lang, Switzerland

Session Code: 3400

Session Type: Mini-Oral

Track: Interdisciplinary

Clinical value of ITV delineation method in cervical cancer patients receiving chemoradiotherapy

Yu-Qin Liang, China

Presentation Number: MO-0887

Abstract

Abstract Title:

Clinical value of ITV delineation method in cervical cancer patients receiving chemoradiotherapy

Authors:

Yu-Qin Liang¹, Sen-Quan Feng², Wen-Jia Xie³, Qiong-Zhi Jiang², Yan-Fen Yang⁴, Ren Luo⁵, Elizabeth A. Kidd⁶, Tian-Tian Zhai⁷, Liang-Xi Xie⁸

¹Xiang'an Hospital of Xiamen University, Department of radiation oncology , Xiamen, China; ²Cancer Hospital of Shantou University, Department of Radiation Oncology, Shantou, China; ³Xiang'an Hospital of Xiamen University, Department of Radiation Oncology, Xiamen, China; ⁴Xiang'an Hospital of Xiamen University, Department of Science and Education, Xiamen, China; ⁵Faculty of Medicine, University of Freiburg, Department of Radiation Oncology, Freiburg, Germany; ⁶Stanford University, Department of Radiation Oncology, California, USA; ⁷Cancer Hospital of Shantou University Medical College, Department of Radiation Oncology, Shantou, China; ⁸Xiang’an Hospital of Xiamen University, Department of Radiation Oncology, Xiamen, China

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Purpose or Objective

To evaluate whether the use of the internal target volume (ITV) delineation method improves the performance of intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3DCRT) in terms of survival, acute toxicities.

Material and Methods

A total of 477 cervical cancer patients who received concurrent chemoradiotherapy (CCRT) from January 2012 to December 2016 were retrospectively analyzed. They were divided into four groups: the non-ITV (N-ITV)+IMRT, ITV+IMRT, N-ITV+3DCRT, and ITV+3DCRT groups, with 76, 41, 327, and 33 patients, respectively. Survival analysis was performed with the Kaplan-Meier and log-rank tests, and acute-toxicity analysis was performed with the chi-square and binary logistic regression tests.

Results

The median follow-up times were 49 months (1-119) and 45 months (1-97) for overall survival (OS) and progression-free survival (PFS), respectively. The 2-year, 3-year, and 5-year OS and PFS rates were 80.1%, 74.0%, 64.1% and 72.9%, 66.4%, 58.3%, respectively.

Compared to the N-ITV group, the ITV group had a better OS (HR (95% CI): 0.52 (0.27, 0.98), p=0.044) and PFS (HR (95% CI): 0.59 (0.36, 0.99), p=0.045) after multivariate analysis. The ITV delineation method was an independent prognostic factor for OS and PFS (Fig. 1).

Of the four groups, the ITV+IMRT group had the lowest incidence of acute Hematological toxicity (HT) (p=0.000). The N-ITV+IMRT group had the highest incidence rates of grade 3 and grade 4 HT, at 31.6% and 14.5%, respectively. Only one patient had grade 4 Cystitis who was from the ITV+IMRT group. ITV+IMRT group was associated with numerically higher rates of acute severe vomiting and diarrhea when compared with the other groups. However, all the differences were not statistically significant(p=0.268, 0.063 respectively).

As shown in Fig. 2, Compared with the ITV+3DCRT group, the N-ITV+IMRT group had a significantly higher rate of acute radiation toxicity, and the ITV+IMRT and N-ITV+3DCRT groups had significantly lower rates of grade ≥3 leukopenia (38.2%, 22.0%, 19.9% vs. 24.2%, p=0.009), grade ≥3 thrombocytopenia (10.5%, 0%, 2.8% vs. 3%, p=0.007), and grade ≥3 neutropenia (35.5%, 17.1%, 13.8% vs. 18.2%, p=0.000). Regarding the impact of chemotherapy regimens on HT, the rates of grade ≥3 myelosuppression were lower in the DDP+PTXLs, nedaplatin and DDP+tegafur groups. They were in the DDP+5-FU and other groups than the DDP chemotherapy group (respectively, 16.1%, 25.9%, 27.6%, 41.7%, and 58.3% vs. 27.8%, p=0.000).

The results of the binary logistic regression model showed that different radiation plan types (ITV+IMRT and N-ITV+3DCRT vs N-ITV+IMRT: HR (95% CI): 0.35 (0.12,1.01) and 0.45 (0.24,0.82), respectively, p=0.052, 0.009) was one of independent risk factors for acute HT.

Fig. 1. Survival comparison between ITV and N-ITV groups.

Fig. 2. Acute HT comparison of groups.

Conclusion

The use of ITV for IMRT treatment planning was associate with improved overall, and progression free survival, with lower HT rate.