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- Title
Adaptive 3D Image-Guided Brachytherapy: A Strong Argument in the Debate on Systematic Radical Hysterectomy for Locally Advanced Cervical Cancer.
- Authors
Mazeron, Renaud; Gilmore, Jennifer; Dumas, Isabelle; Champoudry, Jérôme; Goulart, Jennifer; Vanneste, Ben; Tailleur, Anne; Morice, Philippe; Haie‐Meder, Christine
- Abstract
Purpose. To evaluate the outcomes of patients with locally advanced cervical cancer treated with three-dimensional image-guided brachytherapy (IGABT) after concomitant chemoradiation (CCRT). Materials and Methods. Data from patients treated with CCRT followed by magnetic resonance imaging-guided or computed tomography-guided pulsed-dose-rate brachytherapy, performed according to the Groupe Européen de Curiethérapie- European Society for Radiotherapy and Oncology guidelines, were reviewed. At first, stage I or II patients systematically underwent radical hysterectomy or were offered a randomized study evaluating hysterectomy. Then, hysterectomy was limited to salvage treatment. Results. Of 163 patients identified, 27% had stage IB, 57% had stage II, 12% had stage III, and 3% had stage IVA disease. The mean dose delivered (in 2-Gy dose equivalents) to 90% of the high-risk clinical target volume was 78.1 ± 9.6 Gy, whereas the doses delivered to organs at risk were maintained under the usual thresholds. Sixty-one patients underwent a hysterectomy. Macroscopic residual disease was found in 13 cases. With a median follow-up of 36 months (range, 5--79 months), 45 patients had relapsed. The 3-year overall survival rate was 76%. Local and pelvic control rates were 92% and 86%, respectively. According to the Common Toxicity Criteria 3.0, 7.4% of patients experienced late grade 3 or 4 toxicity. Most of those had undergone postradiation radical surgery (2.9% vs. 14.8; p = .005). Conclusion. IGABT combined with CCRT provides excellent locoregional control rates with low treatment-related morbidity, justifying the elimination of hysterectomy in the absence of obvious residual disease. Distant metastasis remains an important first relapse and may warrant more aggressive systemic treatment.
- Subjects
FRANCE; RADIOISOTOPE brachytherapy; COMBINED modality therapy; HYSTERECTOMY; COMPUTERS in medicine; SURVIVAL analysis (Biometry); THERAPEUTICS; CERVIX uteri tumors; CONTINUING education units; DATA analysis software; DESCRIPTIVE statistics; TUMOR treatment
- Publication
Oncologist, 2013, Vol 18, Issue 4, p415
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2012-0367