IMRT and image-guided adapted brachytherapy for cervix cancer
Menée auprès de 600 patientes atteintes d'un cancer du col utérin traité entre 1997 et 2013 (durée médiane de suivi : 15,3 ans ou 7 ans selon le groupe de patientes), cette étude compare l'efficacité, du point de vue des taux de survie, et la toxicité gastro-intestinale et génito-urinaire d'un traitement combinant radiothérapie avec modulation d'intensité et curithérapie adaptative guidée par images 3D et d'un traitement combinant radiothérapie externe 2D et curiethérapie 2D
Purpose : To report long-term outcomes of cervical cancer patients treated with intensity-modulated radiation therapy and 3D image-guided adapted brachytherapy (IMRT/3D-IGABT) compared to 2D external irradiation and 2D brachytherapy (2D EBRT/BT). Methods and Materials : This study included patients with newly diagnosed cervical cancer and pre-treatment FDG-PET treated with curative-intent irradiation from 1997-2013. Treatment policy changed from 2D EBRT/BT to IMRT/3D-IGABT in 2005. Patterns of recurrence, cancer specific survival (CSS), and overall survival (OS) were evaluated. Late GI and GU toxicity was scored with Common Terminology Criteria for Adverse Events. Results : Median follow-up for patients alive at the time of last follow-up in the 2D EBRT/BT group (n=300) was 15.3 years (10.8-20.5) and in the IMRT/3D-IGABT group (n=300) 7 years (5-12.4). Tumors were FIGO stage IB1-IB2 (33%), IIA-IIB (41%), and IIIA-IVA (26%). The 5-year freedom from recurrence (FFR), CSS, and OS for 2D EBRT/BT patients was 57% FFR, 62% CSS, and 57% OS. For IMRT/3D-IGABT, the 5-year results were 65% FFR (p=0.04), 69% CSS (p=0.01), and 61% OS (p=0.04). When stratified by PET lymph node status, disease control was most improved with IMRT/3D-IGABT vs. 2D EBRT/BT in patients with positive pelvic lymph nodes only (p=0.02). Cumulatively, there were 88 (15%) grade ≥3 late bowel/bladder toxicity (2D EBRT/BT: 55 (18%) vs. IMRT/3D-IGABT: 33 (11%), p=0.02). Conclusions : IMRT/3D-IGABT was associated with improved survival and decreased GI and GU toxicity in cervical cancer patients compared to 2D EBRT/BT.