Definitive radiotherapy consisting of whole pelvic radiotherapy with no central shielding and CT-based intracavitary brachytherapy for cervical cancer: feasibility, toxicity, and oncologic outcomes in Japanese patients.
BACKGROUND
This prospective study investigated the feasibility, toxicity, and oncologic outcomes of definitive radiotherapy (RT) consisting of whole pelvic radiotherapy with no central shielding (noCS-WPRT) and CT-based intracavitary brachytherapy (ICBT) in Japanese patients with cervical cancer.


METHODS
Patients with cervical cancer of FIGO stages IB1-IVA were eligible. The treatment protocol consisted of noCS-WPRT of 45 Gy in 25 fractions and CT-based high dose-rate ICBT of 15 or 20 Gy in 3 or 4 fractions prescribed at point A. The prescribed ICBT dose was decreased if the manual dwell time/position optimization failed to meet organs-at-risk constraints. Graphical optimization and additional interstitial needles were not applied.


RESULTS
We enrolled 40 patients. FIGO stages were IB1: 11, IB2: 13, IIA2: 1, IIB: 11, IIIB: 3, and IVA: 1. Median (range) pretreatment tumor diameter was 47 (14-81) mm. Point A doses were decreased in 19 of 153 ICBT sessions (12%). The median follow-up duration was 33 months. The 2-year rates of pelvic control, local control (LC), and progression-free survival were 83%, 85%, and 75%, respectively. Pre-ICBT tumor diameter, high-risk clinical target volume (HR-CTV), total HR-CTV D90, and overall treatment time (OTT) significantly affected LC. Late adverse events (grade ≥ 3) were observed in 3 patients (2 in the bladder, 1 in the rectum).


CONCLUSIONS
Definitive RT consisting of noCS-WPRT and CT-based ICBT was feasible for Japanese patients with cervical cancer. To further improve LC, additional interstitial needles for patients with a large HR-CTV and shorter OTT should be considered.
['Kusada|Takeaki|T|', 'Toita|Takafumi|T|http://orcid.org/0000-0003-3907-0228', 'Ariga|Takuro|T|', 'Kudaka|Wataru|W|', 'Maemoto|Hitoshi|H|', 'Makino|Wataru|W|', 'Ishikawa|Kazuki|K|', 'Heianna|Joichi|J|', 'Nagai|Yutaka|Y|', 'Aoki|Yoichi|Y|', 'Murayama|Sadayuki|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D044466:Asians D001918:Brachytherapy D005240:Feasibility Studies D005260:Female D006801:Humans D008875:Middle Aged D058958:Organs at Risk D010388:Pelvis D011446:Prospective Studies D011832:Radiation Injuries D011879:Radiotherapy Dosage D012007:Rectum D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D001743:Urinary Bladder D002583:Uterine Cervical Neoplasms
Radiotherapy Brachytherapy Cervix neoplasms