Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate- and high-risk cervical cancer Journal Article

  

Authors:	Folkert, M. R.; Shih, K. K.; Abu-Rustum, N. R.; Jewell, E.; Kollmeier, M. A.; Makker, V.; Barakat, R. R.; Alektiar, K. M.
Article Title:	Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate- and high-risk cervical cancer
Abstract:	Objective According to national surveys, the use of intensity-modulated radiation therapy (IMRT) in gynecologic cancers is on the rise, yet there is still some reluctance to adopt adjuvant IMRT as standard practice. The purpose of this study is to report a single-institution experience using postoperative pelvic IMRT with concurrent chemotherapy in intermediate- and high-risk early stage cervical cancer. Methods From 1/2004 to 12/2009, 34 patients underwent radical hysterectomy and pelvic lymph node dissection (28 median nodes were removed) for early stage cervical cancer. Median dose of postoperative pelvic IMRT was 50.4 Gy (range, 45-50.4). All patients received concurrent cisplatin. Results With a median follow-up of 44 months, 3 patients have recurred; 1 vaginal recurrence, 1 regional and distant, and 1 distant. The 3- and 5-year disease-free survival (DFS) was 91.2% (95% CI, 81.4-100%) and overall survival (OS) was 91.1% (95% CI, 81.3-100%). All failures and all deaths were in the high-risk group (n = 3/26). There was 32.3% G3-4 hematologic toxicity, 2.9% acute G3 gastrointestinal toxicity, and no acute G3 or higher genitourinary toxicity. There were no chronic G3 or higher toxicities. Conclusions Oncologic outcomes with postoperative IMRT were very good, with DFS and OS rates of > 90% at median follow-up of 44 months, despite a preponderance (76.5%) of high-risk features. Toxicity was minimal even in the setting of an aggressive trimodality approach. Data from this study and emerging data from the Phase II RTOG study (0418) demonstrate the advantages of postoperative IMRT in early stage cervical cancer. © 2012 Elsevier Inc. All rights reserved.
Keywords:	adult; aged; cancer surgery; major clinical study; overall survival; intensity modulated radiation therapy; postoperative period; cancer combination chemotherapy; cancer risk; paclitaxel; disease free survival; cancer staging; outcome assessment; follow up; clinical practice; carboplatin; gastrointestinal toxicity; imrt; early cancer; uterine cervix cancer; postoperative; chemoradiation; radical hysterectomy; cervical cancer; intermediate or high risk
Journal Title:	Gynecologic Oncology
Volume:	128
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2013-02-01
Start Page:	288
End Page:	293
Language:	English
DOI:	10.1016/j.ygyno.2012.11.012
PROVIDER:	scopus
PUBMED:	23159818
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84872843530&partnerID=40&md5=d1f8d7aa3a47853c330fdad007d92d86
Notes:	--- - "Export Date: 1 March 2013" - "CODEN: GYNOA" - "Source: Scopus"

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