RESULTS OF ACCELERATED INTRACAVITARY INTERVENTIONAL RADIOTHERAPY SCHEDULES FOR CERVIX CANCER
Valentina Lancellotta,
Italy
PO-2131
Abstract
RESULTS OF ACCELERATED INTRACAVITARY INTERVENTIONAL RADIOTHERAPY SCHEDULES FOR CERVIX CANCER
Authors: Valentina Lancellotta1, Gabriella Macchia2, Bruno Fionda1, Martina De Angeli3, Rosa Autorino1, Maura Campitelli1, Alessandra Salvati1, Gabriella Ferrandina4, Rosa De Vincenzo5, Giovanni Scambia6, Maria Antonietta Gambacorta1, Luca Tagliaferri1
1Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; 2Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Radiation Oncology Unit, Campobasso, Italy; 3Università di Roma, Tor Vergata, Radiation Oncology, Rome, Italy; 4Fondazione Policlinico Universitario "A. Gemelli," Università Cattolica del Sacro Cuore, Gynecologic Oncology Unit, Rome, Italy; 5Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Gynecologic Oncology Unit, Rome, Italy; 6Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Medicine and Health Sciences, Rome, Italy
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Purpose or Objective
The standard of care for stage IB–IVA FIGO cervix cancer consists of chemo-radiation (CRT) followed by image-guided Interventional Radiotherapy (IG-IRT, also called brachytherapy) resulting in excellent local and pelvic control. Although the European brachytherapy group (GEC-ESTRO) has carried out an excellent job in attempting to standardize the contouring of volumes, dose reporting and dose constraints to the target and organs at risk, there is currently a heterogeneity in IRT timing between fractions. The aim of this study was to assess long-term intestinal, urinary, and vaginal toxicities in cervical cancer patients who underwent exclusive radio-chemotherapy followed by accelerated IG-IRT for locally advanced cervical cancer.
Material and Methods
All patients underwent CRT (weekly intravenous cisplatin 40 mg/m2, 5–6 cycles, 1 day per cycle, plus 45 Gy external-beam radiotherapy (EBRT) delivered in 1.8 Gy fractions) +/- simultaneous integrated boost on positive nodes. IG-IRT schedules was as follow:
First week
- Day 1 - Tuesday: MRI of the pelvis, implantation, MRI of the pelvis with applicator, MRI-planning and 1st therapy session
- Day 2 - Wednesday: planning computed tomography (CT) and second IRT fraction delivery
Second week
- Day 10 Thursday and Day 11 Friday: planning CT and third and fourth IRT fraction delivery
The total IRT dose delivered to High Risk Tumor Volume was 28Gy (Total EQD2 dose > 90Gy).
The CTCAE v. 5 scale was used to score the ≥ G3 late vaginal, gastrointestinal and genito-urinary late vaginal toxicity defined as any toxicity occurring six months after completion of HDR-IRT.
Results
Sixteen patients were analysed. Two, four and ten patients were Stage IIB, IIIA/B and IIIC1/2, respectively. The mean EQD2 for 0.1 cm3 of small bowel, rectum and bladder was 65.33Gy, 67.43Gy and 82.22Gy, respectively. The mean EQD2 for 0.2 cm3 of small bowel, rectum and bladder was 62.35Gy, 64.51Gy and 77.4Gy, respectively. The mean EQD2 for recto-vaginal point was 43.10 Gy. At a median follow-up of 14 months the loco-regional control, overall survival and cancer-specific survival were 90%, 97% and 100%, respectively. Late vaginal toxicity was recorded in 15 patients as follow: four, six and three stenosis G1, G2 and G3, respectively; nine, two and three atrophy G1, G2 and G3 respectively; seven and one teleangectasia G1 and G2, respectively. No ≥ G3 late gastrointestinal and genito-urinary toxicity was reported.
Conclusion
In the setting of concurrent chemo-radiotherapy, an accelerated IG-IRT treatment schedules seem to be feasible and safe in terms of late toxicity.