Dose-volume parameters and local tumor control in cervical cancer treated with central-shielding external-beam radiotherapy and CT-based image-guided brachytherapy.
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| Abstract |
Definitive radiotherapy for cervical cancer consists of external-beam radiotherapy (EBRT) and brachytherapy. In EBRT, a central shield (CS) reduces the dose to the rectum and bladder. The combination of whole-pelvic (WP)- and CS-EBRT and brachytherapy is the standard radiotherapy protocol in Japan. Despite clinical studies, including multi-institutional clinical trials, showing that the Japanese treatment protocol yields favorable treatment outcomes with low rates of late radiation toxicities, dose-volume parameters for the Japanese treatment protocol remain to be established. We conducted a retrospective dose-volume analysis of 103 patients with uterine cervical cancer treated with the Japanese protocol using computed tomography-based adaptive brachytherapy. The 2-year overall survival and 2-year local control rates according to FIGO stage were 100% and 100% for Stage I, 92% and 94% for Stage II, and 85% and 87% for Stage III-IV, respectively. Late adverse effects in the rectum and bladder were acceptable. Receiver operating characteristic analysis discriminated recurrence within the high-risk clinical target volume (HR-CTV) (n = 5) from no local recurrence (n = 96), with the optimal response obtained at a dose of 36.0 GyEQD2 for HR-CTV D90 and 28.0 GyEQD2 for HR-CTV D98. These values were used as cut-offs in Fisher exact tests to show that high HR-CTV D90 and HR-CTV D98 doses for brachytherapy sessions were significantly associated with tumor control within the HR-CTV. These data suggest a contribution of brachytherapy to local tumor control in WP- and CS-EBRT and brachytherapy combination treatment, warranting validation in multi-institutional prospective studies.
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| Authors | Shohei Okazaki, Kazutoshi Murata, Shin-Ei Noda, Yu Kumazaki, Ryuta Hirai, Mitsunobu Igari, Takanori Abe, Shuichiro Komatsu, Takashi Nakano, Shingo Kato |
| Journal | Journal of radiation research (J Radiat Res) Vol. 60 Issue 4 Pg. 490-500 (Jul 01 2019) ISSN: 1349-9157 [Electronic] England |
| PMID | 31111896 (Publication Type: Journal Article) |
| Copyright | © The Author(s) 2019. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology. |
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