Customized Radiation of Uterus in Cervical Cancer May Not Compromise Outcomes

receiving chemoradiation, irradiating less than whole uterus led to a low local recurrence rate and less radiation to the bowel but significantly higher locoregional recurrence.At a single institution, researchers developed a more individualized clinical target volume based on the tumor volume that involved the cervix and accounted for organ movement when the bladder was full or empty to decrease radiation to the surrounding bowel.

The researchers identified 109 patients with locally advanced cervical cancer , who received concurrent chemoradiation therapy following this method between 2011 and 2022. Patients underwent external beam radiation therapy using IMRT at a dose of 48.6 Gy delivered in 27 fractions, followed by a boost to 54.0-61.9 Gy targeting the involved lymph nodes. Subsequently, patients received high-dose-rate brachytherapy boost to 27.5-30.0 Gy, employing 5.5-7.0 Gy per fraction. Overall, 53 patients had ≥ 75% of the uterus included in the planning target volume, and 56 had < 75% included.

In patients with ≥ 75% of the uterus included in the final planning target volume, the 2-year cumulative incidence of locoregional recurrence was significantly lower than in patients with < 75% of the uterus included . However, the ≥ 75% group also received a significantly higher dose of radiation to the bowel than those with less uterus included experienced acute grade ≥ 3 gastrointestinal toxicities, and 2 patients experienced late grade ≥ 3 genitourinary toxicities.

"Less than whole uterus irradiation could be considered for carefully selected cervix cancer patients to decrease bowel dose and possible treatment-related toxicity," the team added.The retrospective study design introduced inherent biases. The patient cohort spanned over a decade, making it heterogeneous. A small number of patients lacked an initial staging MRI scan. Retrospective toxicity scoring may have caused underestimation of the actual risk for prospective morbidity.

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