Abstract

To evaluate whether our institutional standard of less than whole uterus (LTWU) irradiation affects locoregional control in patients with locally advanced cervical cancer.We retrospectively reviewed 53 patients with stage IB-IVB cervical carcinoma treated with image-guided IMRT and brachytherapy. The entire uterus was not included in the clinical target volume (CTV), as is our institutional standard. Dosimetric parameters were obtained, including: GTV PET tumor volume, uterus volume excluding GTV, proportion of uterus included in the planning target volume (PTV, %), volume of overlap between uterus and prescription dose (cc), minimum and mean dose to the uterus, and bowel V40 and D200cc. Local, regional, and distant failure, and death were recorded.The median proportion of the uterus included in the PTV was 66%. With a median follow-up of 44 months, no patient experienced isolated local recurrence and 2-year locoregional failure was 10.9%. GTV PET tumor volume correlated significantly with increased chance of any failure (p=0.049; 95% CI, 1.000-1.018). Compared to patients who had =90% of the uterus included in the PTV (n=12), those who had <90% (n=41) of the uterus included in the PTV had significantly lower bowel V40 (p=0.049) and D200cc (p=0.006).LTWU irradiation for locally advanced cervical cancer does not compromise locoregional control and reduces bowel V40 and D200cc. Further investigation is required to evaluate whether this reduction in bowel dose translates to a clinically significant reduction in bowel toxicity and whether modifications should be made to recommended definitive cervix IMRT volumes.

View details for DOI 10.1016/j.prro.2018.10.009

View details for PubMedID 30395974