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Lee SW, Kim A, Lee SJ, Kim SH, Lee JH. Intensity-Modulated Radiation Therapy for Uterine Cervical Cancer to Reduce Toxicity and Enhance Efficacy - an Option or a Must?: A Narrative Review. Cancer Res Treat 2024; 56:1-17. [PMID: 37654111 PMCID: PMC10789959 DOI: 10.4143/crt.2023.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Radiotherapy (RT) is a fundamental modality in treatment of cervical cancer. With advancement of technology, conventional RT used for external beam radiotherapy (EBRT) for over half a century has been rapidly replaced with intensity-modulated radiation therapy (IMRT) especially during the last decade. This newer technique is able to differentiate the intensity of radiation within the same field, thus reduces the inevitable exposure of radiation to normal organs and enables better dose delivery to tumors. Recently, the American Society for Radiation Oncology has released a guideline for RT in cervical cancer. Although a section of the guideline recommends IMRT for the purpose of toxicity reduction, a thorough review of the literature is necessary to understand the current status of IMRT in cervical cancer. This narrative review updates the recent high-level evidences regarding the efficacy and toxicity of IMRT and provides a better understanding of the most innovative techniques currently available for EBRT enabled by IMRT.
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Affiliation(s)
- Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Aeran Kim
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, Seoul, Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Hsieh HY, Lu CH, Wang L. Long-term treatment outcomes/toxicities of definite chemoradiotherapy (intensity-modulated radiation therapy) for early-stage "bulky" cervical cancer and survival impact of histological subtype. J Formos Med Assoc 2023; 122:221-229. [PMID: 36379808 DOI: 10.1016/j.jfma.2022.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/02/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the long-term treatment outcomes of early stage bulky cervical cancer treated with definite chemoradiotherapy (CCRT) using intensity-modulated radiotherapy (IMRT) followed by intracavity brachytherapy (ICRT) and the impact of histologic subtype on survival. METHODS From 2004 to 2016, 126 patients with FIGO stage IB2-IIB bulky (≥4 cm) cervical cancer treated with CCRT followed by ICRT were retrospectively reviewed. Long-term treatment-related acute/late toxicities and treatment outcomes including overall survival (OS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) were reported. Different histologic subtype between squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC)) of uterine cervix were also compared. RESULTS Median follow-up time for alive patients was 117 months. The 5-year OS, LRRFS and DMFS were 75.3%, 87.8% and 75.6%, respectively. The most common ≥ grade 3 acute toxicity was hematologic toxicity (41.3%). The rates of ≥ grade 3 late toxicities were 4% of proctitis, 0.8% of urethral stricture and 0.8% of radiation dermatitis (peri-anal skin necrosis and gangrene). The 5-year OS/LRRFS/DMFS for SCC and AC/ASC were 81.7%/93.7%/81.5% and 51.9%/65.8%/53.5%, respectively (all log-rank p < 0.05). The AC/ASC histology was an independent prognostic factor for worse OS, LRRFS, and DMFS (All p < 0.05). CONCLUSION After long-term follow up, definite CCRT using IMRT followed by ICRT is a feasible treatment with favorable acute and late treatment toxicities for patients with early stage bulky cervical cancer. This treatment outcomes were excellent for "bulky" FIGO stage IB2-IIB SCC of the uterine cervix but seemed insufficient for AC/ASC of uterine cervix.
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Affiliation(s)
- He-Yuan Hsieh
- Department of Radiation Oncology, Taichung Veterans General Hospital, 40705, Taichung, Taiwan
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 40705, Taichung, Taiwan
| | - Lily Wang
- Department of Radiation Oncology, Taichung Veterans General Hospital, 40705, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan.
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Iorio GC, Spieler BO, Ricardi U, Dal Pra A. The Impact of Pelvic Nodal Radiotherapy on Hematologic Toxicity: A Systematic Review with Focus on Leukopenia, Lymphopenia and Future Perspectives in Prostate Cancer Treatment. Crit Rev Oncol Hematol 2021; 168:103497. [PMID: 34666186 DOI: 10.1016/j.critrevonc.2021.103497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/06/2021] [Accepted: 10/10/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hematologic toxicity (HT), particularly leukopenia, is a common side-effect of oncologic treatments for pelvic malignancies. Pelvic nodal radiotherapy (PNRT) has been associated with HT development mainly through incidental bone marrow (BM) irradiation; however, several questions remain about the clinical impact of radiotherapy-related HT. Herein, we perform a systematic review of the available evidence on PNRT and HT. MATERIALS AND METHODS A comprehensive systematic literature search was performed through EMBASE. Hand searching and clinicaltrials.gov were also used. RESULTS While BM-related dose-volume parameters and BM-sparing techniques have been more thoroughly investigated in pelvic malignancies such as cervical, anal, and rectal cancers, the importance of BM as an organ-at-risk has received less attention in prostate cancer treatment. CONCLUSIONS We examined the available evidence regarding the impact of PNRT on HT, with a focus on prostate cancer treatment. We suggest that BM should be regarded as an organ-at-risk for patients undergoing PNRT.
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Affiliation(s)
| | - Benjamin Oren Spieler
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Solis JA, Rosenberg IP, Olivares J, Tudela B, Veillon G, Lazcano G. Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality. Rep Pract Oncol Radiother 2021; 26:360-366. [PMID: 34277089 PMCID: PMC8281917 DOI: 10.5603/rpor.a2021.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background The treatment of early stage cervical cancer has different therapeutic options. Adjuvant external beam radiotherapy for surgically treated intermediate risk cervical cancer patients has shown acceptable oncological outcomes with a low incidence of toxicity. The aim of this study was to analyze the oncological outcomes and safety of adjuvant small pelvic field radiotherapy in surgically treated stage IB1-2 cervical cancer patients who met the Sedlis intermediate-risk criteria. Materials and methods A retrospective cohort study was carried out with 28 patients treated from 2007 to November 2019 with biopsy proven intermediate risk stage IB1–2 cervical cancer previously treated with radical hysterectomy and bilateral lymphadenectomy who received adjuvant small pelvic field radiotherapy. The primary endpoints were local and distant control and overall survival. Secondary endpoints were acute and late gastrointestinal and genitourinary toxicity. Survival curves were analyzed using the Kaplan-Meier method. Results After a median follow up period of 41.5 (27.5–80.5) months, adjuvant small pelvic field radiotherapy showed a 100% overall survival rate, 81.82% disease free survival and 86.36% local recurrence-free survival with no incidence of grade 3 or 4 acute or late toxicity. Three patients suffered from relapse, 1 in the vaginal cuff, 1 in the retrovesical area and 1 patient in the retroperitoneal area. Conclusions Adjuvant small pelvic field radiotherapy is an efficient and safe treatment option that offers excellent oncological outcomes to surgically treated intermediate-risk stage IB1–2 cervical cancer patients with an excellent toxicity profile.
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Affiliation(s)
- José Antonio Solis
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Ilan Perrot Rosenberg
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Jorge Olivares
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Benjamin Tudela
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Gabriel Veillon
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
| | - Gabriel Lazcano
- Radiation Oncology Department, Hospital Carlos Van Buren, City of Valparaíso, Valparaíso Region, Chile.,Universidad de Valparaíso, Faculty of Medicine, Reñaca, Viña del Mar, Valparaíso Region, Chile
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Chu A, Song R, Hou G, Yuan J, Wang C, Yang Y, Qin N, Liu Y, Liang B, Zhang Y, Liu Z. Experimental Study and Clinical Observation on the Improvement Effect of Lienal Polypeptide on Blood Toxicity and Immune Injury Induced by Radiotherapy. Genet Test Mol Biomarkers 2020; 24:73-77. [PMID: 31999489 DOI: 10.1089/gtmb.2019.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims: To investigate the immune and gastrointestinal functional effects of lienal polypeptide (LP) treatment in tumor-bearing mice and carcinoma patients receiving radiotherapy (RT), and to detect hematological indicators and T lymphocyte subsets. Methods: Tumor-bearing mice were randomly divided into five groups: the control group, the RT group, the RT+LP-L (1.7 mg/kg, low dosage of LP) group, the RT+LP-M (5.2 mg/kg, middle dosage of LP) group, and the RT+LP-H (10.4 mg/kg, high dosage of LP) group. In addition, carcinoma patients were randomly divided into two groups. The observation group was given LP during RT, and the control group was only treated with RT. We then compared the myelosuppression, gastrointestinal reactions, and clinical efficacy among groups. Results: In the animal experiments, compared with the control group, the number of leukocytes and lymphocytes of the mice in the "RT" group decreased (p < 0.05). Animals receiving LP evidenced a dose-response curve with regard to the number of leukocytes and lymphocytes that was proportional to the LP dose, increased (p < 0.05). Flow cytometric analyses showed that LP treatment of the mice increased the numbers of CD3+, and CD4+ T cells and theCD4+/CD8+ ratio. In our clinical study, the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) criteria were used for measuring myelosuppression and gastrointestinal reactions. The RTOG/EORTC grade 3 or 4 inhibition rate of leukocytes, granulocytes, hemoglobin, platelets, and gastrointestinal toxic effects in the observation group were significantly lower than that in the control group (p < 0.05). Conclusion: LP can improve the hematopoietic and immune function of RT-treated mice and reduce the hematological and gastrointestinal toxicity of patients treated with RT and improve the quality of life.
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Affiliation(s)
- Alan Chu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Song
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ge Hou
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinjin Yuan
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cheng Wang
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Yang
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ning Qin
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaohe Liu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bing Liang
- Department of Oncology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Department of Pharmacology, School of Basic Medical of Zhengzhou University, Zhengzhou, China
| | - Zongwen Liu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:220-234. [DOI: 10.1016/j.prro.2020.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
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Long-term results of fertility-sparing treatment for early-stage cervical cancer. Gynecol Oncol 2019; 154:89-94. [DOI: 10.1016/j.ygyno.2019.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 11/21/2022]
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