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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.