Abstract

BACKGROUND: To evaluate whether the use of the internal target volume (ITV) delineation method improves the performance of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) in terms of survival, acute toxicities, and dose-volume parameters.METHODS: A total number of 477 cervical cancer patients who received concurrent chemoradiotherapy (CCRT) from January 2012 to December 2016 were retrospectively analyzed. They were divided into four groups: the non-ITV (N-ITV)+IMRT, ITV+IMRT, N-ITV+3DCRT, and ITV+3DCRT groups, with 76, 41, 327, and 33 patients, respectively. Survival analysis was performed with the Kaplan-Meier and the log-rank tests, and acute toxicity analysis was performed with the chi-squared test and the binary logistic regression test. Using the propensity score matching (PSM) method, 92 patients were matched among the four groups, and their dose-volume parameters were assessed with the Kruskal-Wallis method.RESULTS: The median follow-up time was 49months (1-119) for overall survival (OS). The 5-year OS rate was 66.4%. The ITV delineation method was an independent prognostic factor for OS (HR [95% CI]: 0.52 [0.27, 0.98], p=0.044) and progression-free survival (PFS) (HR [95% CI]: 0.59 [0.36, 0.99], p=0.045). The ITV+IMRT group had the lowest incidence rate (22%) and the N-ITV+IMRT group had the highest incidence rate of grade =3hematological toxicity (HT) (46.1%) among the four groups. The pelvic bone marrow relative V10, V20, and V30 in the N-ITV+IMRT group was higher than those in the ITV+IMRT and N-ITV+3DCRT groups (p<0.05).CONCLUSIONS: The use of ITV for IMRT treatment planning was associated with improved overall survival and progression-free survival, with lower HT rate.

View details for DOI 10.1002/cam4.4439

View details for PubMedID 34821082