Intensity-modulated extended-field chemoradiation plus simultaneous integrated boost in the pre-operative treatment of locally advanced cervical cancer: A dose-escalation study

Vito Chiantera, Aida Di Stefano, Giovanni Scambia, Savino Cilla, Francesco Legge, Francesco Deodato, Vito Chiantera, Gabriella Ferrandina, Gabriella Macchia, Vincenzo Valentini, Alessio G. Morganti, Giovanni Scambia

Risultato della ricerca: Articlepeer review

5 Citazioni (Scopus)

Abstract

Objective: To investigate the feasibility and determine the recommended pre-operative intensity-modulated radiotherapy (IMRT) dose of extended-field chemoradiation along with simultaneous integrated boost (SIB) dose escalation. Methods: A radiation dose of 40Gy over 4 weeks, 2Gy/fraction, was delivered to the tumour and the lymphatic drainage (planning target volume, PTV3), which encompassed a volume larger than standard (common iliac lymphatic area up to its apex, in front of the L3 vertebra), concurrently with chemotherapy (cisplatin and 5-fluorouracil). Radiation dose was escalated to the pelvis (PTV2) and to the macroscopic disease (PTV1) with the SIB-IMRT strategy. Three dose levels were planned: Level 1 (PTV3: 40/2Gy; PTV2: 40/2Gy; PTV1: 45/2.25Gy), Level 2 (PTV3: 40/2Gy; PTV2: 45/2.25Gy; PTV1: 45/2.25Gy) and Level 3 (PTV3: 40/2Gy; PTV2: 45/2.25Gy; PTV1: 50/ 2.5Gy). All treatments were delivered in 20 fractions. Patients were treated in cohorts of between three and six per group using a Phase I study design. The recommended dose was exceeded if two of the six patients in a cohort experienced dose-limiting toxicity within 3months fromtreatment. Results: 19 patients [median age: 46 years; The International Federation of Gynecology and Obstetrics (FIGO) stage IB2: 3, IIB: 10, IIIA-IIIB: 6] were enrolled. Median follow-up was 24 months (9-60 months). The most common grade 3/4 toxicity was gastrointestinal (GI) (diarrhoea, mucous discharge, rectal/abdominal pain). At Levels 1 and 2, only one grade 3 GI toxicity per level was recorded, whereas at Level 3, two grade 3 GI toxicities (diarrhoea, emesis and nausea) were recorded. Conclusion: The SIB-IMRT technique was found to be feasible and safe at the recommended doses of 45Gy to PTV1 and PTV2 and 40Gy to PTV3 in the pre-operative treatment of patients with locally advanced cervical cancer. Unfortunately, this complex technique was unable to safely escalate dose beyond levels already achieved with three-dimensional conformal radiotherapy technique given acute GI toxicity. Advances in knowledge: A Phase I radiotherapy doseescalation trial with SIB-IMRT technique is proposed in cervical cancer. This complex technique is feasible and safe at the recommended doses.
Lingua originaleEnglish
pagine (da-a)20150385-
Numero di pagine9
RivistaBritish Journal of Radiology
Volume88
Stato di pubblicazionePublished - 2015

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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