(P022) Effectiveness of Intensity-Modulated Radiation Therapy With Simultaneous Integrated Boost in Cervical Cancer Patients With Positron Emission Tomography (PET)-Positive Lymph Nodes

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Article
OncologyOncology Vol 30 No 4_Suppl_1
Volume 30
Issue 4_Suppl_1

Intensity-modulated radiation therapy with simultaneous integrated boost to PET-positive nodes is well tolerated and provides good local control and OS in node-positive cervical cancer patients.

John W. Shumway, BA, Alfredo E. Echeverria, MD, Umang Patel, MD, Mark D. Bonnen, MD, Michelle S. Ludwig, MD, MPH, PhD; Baylor College of Medicine

PURPOSE: Evaluate the effectiveness of intensity-modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB) in cervical cancer patients with positron emission tomography (PET)-positive lymph nodes. Although it is not a Radiation Therapy Oncology Group–recommended treatment modality, due to overall poor prognosis, we utilize this technology in this class of patients.

MATERIALS AND METHODS: Forty patients with pelvic node–positive cervical cancer (International Federation of Gynecologists and Obstetricians [FIGO] stage IB1–IVB) treated with definitive chemoradiation from 2013–2014 with IMRT were retrospectively analyzed. Patients were treated with IMRT, with the pelvis and uninvolved nodes receiving 1.8 Gy/day to 45–50.4 Gy and the PET-positive nodes treated at 2.07 Gy/day to 51.75–57.96 Gy, depending on bowel tolerance. Patients then received brachytherapy, followed by a boost, to bring positive nodes to 60–66 Gy. Full and empty bladder simulations and cone beam CT were utilized to optimize reproducibility.

RESULTS: Patients had a median of six PET-positive nodes. A total of 17 patients (43%) received full extended-field IMRT for PET-positive para-aortic nodes (up to T12), and 11 patients (28%) received partial extended-field IMRT for PET-positive common iliac nodes (up to L2). With a mean follow-up of 16 months, 15 patients (37%) had recurrent or persistent disease. Sites of recurrent/persistent disease were cervix (6 [15%]), regional nodes (6 [15%]), and distant (10 [26%]). The 2-year overall survival (OS) was 87% (standard error [SE], 0.6), and 2-year progression free survival (PFS) was 63% (SE, 0.9). Treatment was well tolerated; 15 patients (38%) experienced grade 2 gastrointestinal (GI) toxicity, and 1 patient (2%) experienced a grade 3 adverse GI event. With full extended-field IMRT, seven patients (18%) experienced grade 2 adverse GI events vs five patients (13%) with partial extended-field IMRT. Neither group experienced grade 3 adverse GI events.

CONCLUSIONS: IMRT with SIB to PET-positive nodes is well tolerated and provides good local control and OS in node-positive cervical cancer patients.

Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) A 15-Year Review of Radiation Therapy for Keloids at Two Institutions
(S003) Single-Fraction Radiation Therapy for the Treatment of Multiple Myeloma Bony Metastases Provides Pain Control and Decreases Time to Chemotherapy
(S001) Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation Therapy for Oropharyngeal Cancer
(S004) Trend in Second Malignancy Risk for Head and Neck Cancer With Increased Utilization of IMRT: Analysis of SEER Database
(S005) Comparison of Legal Needs of a Group of Patients With Cancer: Economic and Geographic Factors
(S006) Mission Improvement: Lessons From Initiating a Resident-Led Quality Improvement Project on Smoking Cessation at a County Hospital
(S007) Results of a Phase II Trial Using Cetuximab Plus Docetaxel With Low-Dose Fractionated Radiation for Recurrent Unresectable Locally Advanced Head and Neck Carcinoma
(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status
(S009) Intensity-Modulated Radiation Therapy With Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: A Report on Three-Year Toxicity
(S011) Comparative Study Between Ileal Conduit and Indiana Pouch After Cystectomy for Patients With Carcinoma of Urinary Bladder
(S010) Computed Tomography–Assessed Measures of Bone Mineral Density and Muscle Mass as Predictors of Survival in Men With Prostate Cancer
(S012) Quantitative Imaging to Evaluate the Malignant Potential of Pancreatic Cysts
(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma
(S014) The Impact of Radiation Therapy on Survival in Surgically Resected, High-Risk Patients With Ampullary Adenocarcinoma: A Population-Based Analysis
(S016) The Impact of Stereotactic Body Radiation Therapy on Overall Survival in Patients With Locally Advanced Pancreatic Cancer
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