Abstract

PURPOSE: To report long-term outcomes of cervical cancer patients treated with intensity-modulated radiation therapy and 3D image-guided adapted brachytherapy (IMRT/3D-IGABT) compared to 2D external irradiation and 2D brachytherapy (2D EBRT/BT).METHODS AND MATERIALS: This study included patients with newly diagnosed cervical cancer and pre-treatment FDG-PET treated with curative-intent irradiation from 1997-2013. Treatment policy changed from 2D EBRT/BT to IMRT/3D-IGABT in 2005. Patterns of recurrence, cancer specific survival (CSS), and overall survival (OS) were evaluated. Late GI and GU toxicity was scored with Common Terminology Criteria for Adverse Events.RESULTS: Median follow-up for patients alive at the time of last follow-up in the 2D EBRT/BT group (n=300) was 15.3 years (10.8-20.5) and in the IMRT/3D-IGABT group (n=300) 7 years (5-12.4). Tumors were FIGO stage IB1-IB2 (33%), IIA-IIB (41%), and IIIA-IVA (26%). The 5-year freedom from recurrence (FFR), CSS, and OS for 2D EBRT/BT patients was 57% FFR, 62% CSS, and 57% OS. For IMRT/3D-IGABT, the 5-year results were 65% FFR (p=0.04), 69% CSS (p=0.01), and 61% OS (p=0.04). When stratified by PET lymph node status, disease control was most improved with IMRT/3D-IGABT vs. 2D EBRT/BT in patients with positive pelvic lymph nodes only (p=0.02). Cumulatively, there were 88 (15%) grade =3 late bowel/bladder toxicity (2D EBRT/BT: 55 (18%) vs. IMRT/3D-IGABT: 33 (11%), p=0.02).CONCLUSIONS: IMRT/3D-IGABT was associated with improved survival and decreased GI and GU toxicity in cervical cancer patients compared to 2D EBRT/BT.

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