Results of Definitive (Chemo)radiotherapy Using Computed Tomography-based Brachytherapy for Cervical Cancer

• Published in: Anticancer research Vol. 44; no. 4; pp. 1583 - 1589
• Main Authors: Aoshika, Tomomi, Noda, Shin-Ei, Abe, Takanori, Kumazaki, Y U, Hirai, Ryuta, Igari, Mitsunobu, Saito, Satoshi, Ryuno, Yasuhiro, Iino, Misaki, Takeda, Yuga, Ohta, Tomohiro, Watanabe, Jun, Tsukahara, Keita, Kato, Shingo
• Format: Journal Article
• Language: English
• Published: Greece International Institute of Anticancer Research 01.04.2024
• Subjects: Brachytherapy; Brachytherapy - methods; Cancer; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - therapy; Cervical cancer; Cervical carcinoma; Cervix; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemotherapy; Cisplatin; Cisplatin - therapeutic use; Computed tomography; Failure; Female; Health care facilities; Health services; Humans; Magnetic resonance; Magnetic resonance imaging; Neoplasm Staging; Neoplasms; Patients; Radiation therapy; Retrospective Studies; Squamous cell carcinoma; Survival; Tomography; Tomography, X-Ray Computed - methods; Toxicity; Treatment Outcome; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - radiotherapy; radiotherapy; 3D image-guided brachytherapy; Uterine cervical cancer; local control; progression-free survival; squamous cell carcinoma
• ISSN: 0250-7005; 1791-7530
• DOI: 10.21873/anticanres.16956

Concurrent cisplatin-based chemoradiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer. Especially, CCRT with magnetic resonance imaging (MRI) or computed tomography-based image-guided brachytherapy (CT-based 3D-IGBT) for cervical cancer has resulted in good LC rates. However, progression-free survival (PFS) and overall survival (OS) rates for locally advanced cervical cancer are still low and could be improved. The aim of the study was to evaluate treatment efficacy and late toxicity of external beam radiotherapy (EBRT) and CT-based IGBT with or without concurrent chemotherapy in patients with squamous cell carcinoma of the uterine cervix and investigate patterns of failure. We retrospectively analyzed clinical data of cervical squamous cell carcinoma patients treated with definitive radiotherapy with or without concurrent chemotherapy at Saitama Medical University International Medical Center. Local control (LC), PFS, patterns of failure, and late toxicity were the evaluated outcomes. Overall, 290 patients were enrolled in the study. Median follow-up was 51.5 months. During follow-up, 74 patients developed recurrence: 10 patients with intra-pelvic failure only, 45 with extra-pelvic failure only, and 19 with both. The 3-year LC was 100% for T1b-T2a, 96.8% for T2b, 89.5% for T3b, and 88.5% for T4 disease. The 3-year PFS was 100% for stage IB-IIA, 89.0% for stage IIB, 70.7% for stage IIIB, 72.6% for stage IIIC1r, and 40.1% for stage IVA. The incidence of grade 3-4 gastrointestinal and genitourinary toxicities was 3.0% and 1.7%, respectively. Combination of EBRT and CT-based IGBT with or without concurrent chemotherapy produced favorable LC with acceptable rates of late toxicities. However, extra-pelvic failures frequently occurred and PFS was less satisfactory in patients with stage III-IVA disease, which indicated the need for additional treatment in these patients.