PV QA 4 - Poster Viewing Q&A 4
TU_14_3461 - Extended-Field Intensity Modulated Radiation Therapy (EF-IMRT)and Intra-Cavitary Brachytherapy Combined with Chemotherapy in Cervical Cancer: A Multicenter-Clinical Trial
Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3
Extended-Field Intensity Modulated Radiation Therapy (EF-IMRT)and Intra-Cavitary Brachytherapy Combined with Chemotherapy in Cervical Cancer: A Multicenter-Clinical Trial
K. Hu1, J. Ma2, F. Zhang3, L. Wei4, J. He5, F. Zhao6, W. Zhong7, G. Cheng8, B. Sun9, P. Wang10, Y. Shi11, and H. Zhu12; 1Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 2Department of Radiation Oncology, Peking Union Medical College Hosipital, Beijing, P.R. China, Beijing, China, 3Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 4Xijing Hospital, Xian 710032, China, 5Department of Radiation Oncology, General Hospital of Ningxia Medical University (Cancer hospital), Ningxia, China, Ningxia, China, 6Department of Radiation Oncology, Gansu Provincial Cancer Hospital, China, Gansu, China, 7Department of Radiation Oncology, Cancer Hospital Affiliated to Xinjiang Medical University, China, Xinjiang, China, 8Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China, 9Department of Radiation Oncology, Jilin Cancer Hospital, China, Jinlin, China, 10Department of Radiation Oncology, Tangshan People’s Hospital, Hebei, China, Tangshan, China, 11Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 12Xiangya Hospital, Central South University, Changsha, China
Purpose/Objective(s): A prospective study in multicenter was carried out to evaluate the safety and efficacy of EF-IMRT with concurrent chemotherapy in patients with locally advanced cervical cancer.
Materials/Methods: 154 patients with FIGO stage IB-IIIB cervical cancer from 10 Chinese tertiary hospitals were enrolled from May 2015 to Jun 2017. Inclusion Criteria also included：1）with common iliac node or para‑aortic node involvement, 2）ECOG ≤ 2，3）without distant metastasis(para‑aortic nodes metastasis are not taken into account), 4) All patients signed informed consent. All patients were treated with EF‑IMRT and brachytherapy with concurrent platinum-based chemotherapy (40 mg/m2). A total dose of 45-50.4Gy in 25 to 28 fractions was delivered by EF-IMRT, with a concomitant boost of involved lymph nodes to a dose of 60Gy. High-dose rate brachytherapy was delivered to a total dose of 30Gy in 5 fractions. The primary endpoint was to evaluate the toxicities. Overall survival rates(OS), progression-free survival(PFS), locoregional failure, incidence of distant metastasis, and cancer related death were the secondary endpoints. Adverse events were graded in accordance with Common Terminology Criteria for Adverse Events v4.0. Survival data were analyzed with Kaplan-Meier methods.
Results: Of the 154 patients, 53.9% patients had FIGO IIB disease and 28.5% patients had FIGO III disease. 78.6% patients had involved para‑aortic nodes, and 21.4% patients only had common iliac involved. All patients completed the treatment with a mean treatment duration of 53.8±8.3days. 87% patients received 3-6 cycles of concurrent chemotherapy. The median follow-up time was 11.5 (3-28) months. 66.4% and 16.8% patients had acute Grade 3-4 hematologic adverse effects and gastrointestinal toxicities, respectively. One patient died of severe lung infection in 3 months after the treatment. For late adverse effect, 6% patients experienced Grade 3 hematologic toxicities and 2% patients had late Grade 3 gastrointestinal toxicities. The 1-year and 2-year overall survival rates(OS) were 91.6% and 73.6%, respectively. The mean PFS time was 11.6months, and the 1‑ and 2‑year PFS rates were 78.4% and 70.9%, respectively. For patients with para‑aortic node involvement and patients with only common iliac nodes involvement, the 1-year PFS rates were 77.1% and 83.7%, respectively. A total of 32 patients (20.8%) experienced treatment failure, of which 26 patients developed distant metastasis. The 2-year locoregional control rate was 86%.
Conclusion: The preliminary results suggest the toxicities of EF-IMRT with concurrent chemotherapy in cervical cancer are tolerable. EF-IMRT provided a favorable local control in para-aortic nodes involved advanced cervical cancer. Distant metastasis was the main cause for treatment failure.
Author Disclosure: K. Hu: None. F. Zhang: None. L. Wei: None. F. Zhao: None.