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Table 4 Literature overview

From: Dose escalated intensity modulated radiotherapy in the treatment of cervical cancer

Author and year of publication Therapy seetings and study type IMRT EBRT total dose/EBRT daily dose Brachytherapy total dose Number of patients treated with IMRT FIGO Stage Number of patients with positive pelvic lymph nodes Number of patients with negative lymph nodes Follow-up (median) in months Total number of patients with disease relapse Loco-regional failure DFS/patient alive without sign of disease OS/alive at last follow up Acute gastrointestinal or genitourinary toxicites Gr 3 or greater Chronic gastrointestinal or genitourinary toxicites Gr 3 or greater Normal tissue planning constraints
Gerszten et al., [23] Definitive, extended field IMRT, retrospective 45 Gy and 55 Gy to involved nodes 25 Gy/5 Gy 22 IB-IIIB 9 (receiving nodal boost) 2 positive on surgical staging 11 No data No data No data No data No data 0 Not evaluated rectal maximum dose: 54 Gy with no more than 40 % of the rectal volume receiving 40 Gy; bladder maximum dose 54 Gy with no more than 50 % at 40 Gy; small bowel maximum 50 Gy with no more than 35 % of small bowel receiving 35 Gy.
Kidd et al., [6] Definitive 18 FDG PET based IMRT, retrospective comparison with non-IMRT radiochemotherapy 50 Gy to whole pelvis and additional 20 Gy to central region (cervix) 6 weekly fraction of 6.5 Gy HDR 135 IBI-IVA 41 (30.4 %) 68 (50.4 %) 22 (range, 5–47 months) 39 11 (8.1 %) 91 (67.4 %) pts No data No data 8 (6 %) <40 % of bowel to receive 30 Gy, <40 % of rectum to receive 40 Gy, <40 % of pelvic bones to receive 40 Gy, and <40 % of femoral heads to receive 30 Gy.
Hasselle et al., [25] Definitive IMRT in 81 patients. Retrospective multicentric study. median 45 Gy (range: 39.6 - 50.4 Gy)/1.8 Gy LDR 35 to 40 Gy; 5 HDR fractions to 27.5 to 30 Gy 111 (22 postop, 8 with consecutive surgery) I–IVA No data No data 26.6 (range, 5.4–99.0 months) No data The 3-year pelvic failure rate - 29.2 % 69 % (95 % CI, 59–81 %) 78 % (95 % confidence interval [CI], 68–88 %) 2 % (95 % CI, 0–7 %) 7 % (95 % CI, 2–13 %) rectum: maximum dose < 50 Gy; bowel V45 < 250 mL, pelvic BM V20 < 75 %, V10 < 90 %; bladder: as low as reasonably achievable
Chen et al., [26] Definitive, IMRT, retrospective 45–54 Gy, (54–60 nodes simultan boost) HDR 20 – 33.5 Gy/4–6 Gy/Fraction 2 x Week 109 IB2 - IVA 14 82 32.5 for survival pts (5–75) 5 (4.6 %) locoregional only; 14(12.8 %) distant only; 29 (26.6 %) in total; 21.9 % at 3 year 67.6 % at 3 year 78.2 % at 3 year 3 pts (GI Only) 5 (4.6 %) GI 7 (6.4 %) GU rectum: V30 < 50 %; small bowel: V30 < 15 %;
Du XL et al., [29] Definitive RT-CH. Comparison of reduced field IMRT with conventional EBRT. 30 Gy to whole pelvis with additional boost of 30 Gy to lymphatic drainage region as well as paracervix and parametrium. HDR 10–30 Gy/5–6 Gy SD 60 IIB–IIIB No data No data 7 months (range, 6 - 68 months) 64.90 % No data 64.9 % PFS at 5 y 82.5 % at 3 y; 71.2 % at 5 y 7 0 No data
Gandhi et al. [8] Definitive radio chemotherapy. Nonblind, prospective, randomized, phase II trial. Comparison with whole pelvis conventional radiotherapy 50.4 Gy/1.8 Gy 21 Gy/7 Gy SD 22 IIB-IIIB No data No data 21.6 months (range, 7.7-34.4 months). 5 (22.7 %) 2 (9.1 %) 60 % at 27 months 85.7 % at 27 months 2 0 small bowel: volume receiving 40 Gy (V40) <32 %, maximum dose <50 Gy; rectum: V40 < 40 %, maximum dose <50 Gy; bladder: V40 < 40 %, maximal dose < 50 Gy
Jensen LG et al., [31] Definitive, extended-field intensity-modulated radiotherapy 45 to 50.4, median boost dose to parametrian: 9 Gy or pelvic LN 10 Gy in 16 pts, PA boost of median 10.4 Gy in 6 pts LDR 35 to 40 Gy 1 or 2 x; HDR 19.8 to 30 3 to 5 x 21 IB1 - IIIB 14 patients had paraaortic LN and 20 pelvic LN 0 22 (range, 12 to 56 months) for survived patients 11 No data 42.9 % (95 % CI, 26.2 % Y70.2 %). At 11 months 59.7 % (95 % confidence interval [CI], 41.2 % Y86.4 %) at 11 months 4(19 %) 2 (9.5 %) rectum: maximum dose < 50 Gy; bowel: V45 < 250 cm3; bladder: as low as reasonably achievable.
Cihoric et al. [11] Definitive dose escalated IMRT, retrospective 50.4 to whole pelvis, 5.4 to 9 Gy boost to central disease, 62 Gy to lymph nodes HDR TD 15–18 Gy with 4–6.5 Gy SD 39 IB2 to IVA 24 (61.5 %) 15 36 (3–71 months) 14 (35.9 %) 9 (23.1 %) patient with pelvic failure; LRFS was 55.2 ± 4.4 months 25 (64.1 %). The mean DFS: 47.2 ± 4.9 months Mean OS time for the entire cohort: 61.1 ± 3.5 months 2 (5.2 %) 2 (5.2 %) 60 % of rectum < 50 Gy, 35 % of bowel < 35Gy, 50 % of bladder < 50 Gy and 10 % of the femoral heads < 50 Gy.