A comparative study of intensity-modulated radiotherapy and standard radiation field with concurrent chemotherapy for local advanced cervical cancer

Objective: This study aimed to compare three-dimensional conformal radiotherapy (3D CRT) and intensity-modulated radiotherapy (IMRT) combined with concurrent chemotherapy for cervical cancer. Materials and Methods: A total of 72 patients with Grades IIa–IIIb cervical cancer were randomly divided into two groups, namely, the IMRT group for IMRT plan (primary lesion, 45 Gy/22; the pelvic wall lymphatic drainage area, 50 Gy/22), and the 3D CRT group (conformal pelvic radiotherapy, 45 Gy/22; subsequent supplement of pelvic wall, 6.0 Gy/3). Both groups received concurrent chemotherapy of nedaplatin 30 mg/m2 weekly for six cycles, with an after-loading therapy of 6 Gy/6 each time. Results: In the IMRT group, the grade III diarrhea rate was 5.6% and the rate in the 3D CRT group was 30.6%; both groups significantly differed. No significant difference was observed between the overall survival and disease-free survival in first, second, and third years in both groups. Conclusion: Cervical cancer IMRT can significantly reduce the incidence of acute enteritis. For standard 3D CRT, no significant difference was observed in overall survival and disease-free survival.

Cervical cancer; Three-dimensional conformal radiotherapy; Intensity-modulated radiotherapy; Efficacy.

[1] Portelance L., Chao K.S., Grigsby P.W., Bennet H., Low D.: “Intensity- modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation”. Int. J. Radiat. Oncol. Biol. Phys., 2001, 51, 261.

[2] Heron D.E., Gerszten K., Selvaraj R.N., King G.C., Sonnik D., Gallion H. et al: “Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosimetric study of dose-volume histograms small star, filled”. Gynecol. Oncol. 2003, 91, 39.

[3] D’Souza W.D., Ahamad A.A., Iyer R.B., Salehpour M.R., Jhingran A., Eifel P.J.: “Feasibility of dose escalation using intensity-modulated radiotherapy in posthysterectomy cervical carcinoma”. Int. J. Radiat. Oncol. Biol. Phys. 2005, 61, 1062.

[4] Green J.A., Kirwan J.M., Tierney J.F., Symonds P., Fresco L., Collingwood M. et al.: “Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis”. Lancet, 2001, 358, 781.

[5] Beriwal S., Gan G.N., Heron D.E., Selvaraj R.N., Kim H., Lalonde R. et al: “Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer”. Int. J. Radiat. Oncol. Biol. Phys., 2007, 68, 166.

[6] Folkert M.R., Shih K.K., Abu-Rustum N.R., Jewell E., Kollmeier M.A., Makker V. et al.: “Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate - and high-risk cervical cancer”. Gynecol. Oncol., 2013,128, 288.

[7] Trotti A., Colevas A.D., Setser A., Rusch V., Jaques D., Budach V. et al.: “CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment”. Semin. Radiat. Oncol., 2003, 13, 176.

[8] Monk B.J., Tewari K.S., Koh W.J.: “Multimodality therapy for locally advanced cervical carcinoma: state of the art and future directions”. J. Clin. Oncol., 2007, 25, 2952.

[9] Song W.Y., Huh S.N., Liang Y., White G., Nichols R.C., Watkins W.T. et al.: “Dosimetric comparison study between intensity modulatedm radiation therapy and three-dimensional conformal proton therapy for pelvic bone marrow sparing in the treatment of cervical cancer”. J. Appl. Clin. Med. Phys., 2010, 11, 3255.

[10] Chen M.F., Tseng C.J., Tseng C.C., Yu C.Y., Wu C.T., Chen W.C.: “Adjuvant concurrent chemoradiotherapy with intensity-modulated pelvic radiotherapy after surgery for high-risk, early stage cervical cancer patients”. Cancer J., 2008, 14, 200.

[11] Kavanagh B.D., Schefter T.E., Wu Q., Tong S., Newman F., Arnfield M. et al.: “Clinical application of intensity-modulated radiotherapy for locally advanced cervical cancer”. Semin. Radiat. Oncol., 2002, 12, 260.

[12] Guerrero M., Li X.A., Ma L., Deyoung C., Erickson B.: “Simultaneous integrated intensity-modulated radiotherapy boost for locally advanced gynecological cancer: radiobiological and dosimetric considerations”. Int. J. Radiat. Oncol. Biol. Phys., 2005, 62, 933.

[13] Salama J.K., Mundt A.J., Roeske J., Mehta N.: “Preliminary outcome and toxicity report of extended-field, intensity-modulated radiation therapy for gynecologic malignancies”. Int. J. Radiat. Oncol. Biol. Phys., 2006, 65, 1170.

[14] Lai S.Z., Li W.F., Chen L., Luo W., Chen Y.Y., Liu L.Z. et al.: “How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients”? Int. J. Radiat. Oncol. Biol. Phys., 2011, 80, 661.

[15] Pearcey R., Miao Q., Kong W., Zhang-Salomons J., Mackillop W.J.: “Impact of adoption of chemoradiotherapy on the outcome of cervical cancer in Ontario: results of a population-based cohort study”. J. Clin. Oncol., 2007, 25, 2383.

[16] Vale C., Tierney J.F., Stewart L.A., Brady M., Dinshaw K., Jakobsen A. et al.: “Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials”. J. Clin. Oncol., 2008, 26, 5802.

[17] Chen M.F., Tseng C.J., Tseng C.C., Kuo Y.C., Yu C.Y., Chen W.C.: “Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: comparison with conventional radiotherapy”. Int. J. Radiat. Oncol. Biol. Phys., 2007, 67, 1438.

[18] Koshiyama M., Kinezaki M., Uchida T., Sumitomo M.: “Chemosensitivity testing of a novel platinum analog, nedaplatin (254-S), in human gynecological carcinomas: a comparison with cisplatin”. Anticancer Res., 2005, 25, 499.

[19] Moore K.N., Herzog T.J., Lewin S., Giuntoli R.L., Armstrong D.K., Rocconi R.P. et al.: “A comparison of cisplatin/paclitaxel and carboplatin/ paclitaxel in stage IVB, recurrent or persistent cervical cancer”. Gynecol. Oncol., 2007, 105, 299.

[20] Mollà M., Escude L., Nouet P., Popowski Y., Hidalgo A., Rouzaud M. et al.: “Fractionated stereotactic radiotherapy boost for gynecologic tumors: an alternative to brachytherapy”? Int. J. Radiat. Oncol. Biol. Phys., 2005, 62, 118.

[21] Grigsby P.W., Perez C.A., Chao K.S., Mutch D.G., Lockett M.A.: “Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix”. Int. J. Radiat. Oncol. Biol. Phys., 1998, 41, 307.