Tom 5, Nr 5 (2020)
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Opublikowany online: 2020-09-03

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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

The impact of cervical (GTVCRX) and parametrial (GTVLP, GTVRP) volumetric status on efficacy of radiotherapy for uterine cervix cancer in stage IIB and IIIB

Ewa Telka1, Bogusław Maciejewski2, Leszek Hawrylewicz3, Bożena Jochymek1, Magdalena Markowska2
Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2020;5(5):235-240.


Introduction. The impact of volumetric staging of cervix and parametria on treatment outcome after combined BRT and IMRT of 135 cervix cancer patients in stage IIB and IIIB is analysed.

Material and methods. Cervical GTVCRX and parametrial (GTVLP, RP) volumes are subdivided into four subgroups. BRT with 30 Gy in three fractions was combined with IMRT 48 Gy in 24 fractions. For GTVCRX ≤35 cm3 5-year local control (LC) was 100%, which decreased to 87% for GTVCRX ≥130 cm3.

Results. Cervix and parametrial local recurrence were not higher than 3%. Major failures were periaortal nodes metastases (PNM) occurring during 5-year follow-up. Dose of ≥60 izoGy2.0 effectively prevented the PNM. Underdosage <55 izoGy2.0 (GTVRP) resulted in an increasing PNM from 7% to 53%, strongly correlated with enlarging GTVCRX from 5 cm3 to >130 cm3.

Conclusion. Although cervix and parametria volumetric status are highly heterogeneous, they turned out to be better prognostic predictors than traditional TNM grading.

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  1. Wiebe E, Denny L, Thomas G. Cancer of the uterine cervix. FIGO Cancer Report 2012. Int J Gynecol Obst. ; 2012: 100–109.
  2. Jastaniyah N, Yoshida K, Tanderup K, et al. EMBRACE Collaborative Group. A volumetric analysis of GTV and CTV as defined by the GEC ESTRO recommendations in FIGO stage IIB and IIIB cervical cancer patients treated with IGABT in a prospective multicentric trial (EMBRACE). Radiother Oncol. 2016; 120(3): 404–411.
  3. Studer G, Lütolf UM, El-Bassiouni M, et al. Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol. 2007; 46(3): 386–394.
  4. Plataniotis GA, Theofanopoulou ME, Kalogera-Fountzila A, et al. Prognostic impact of tumor volumetry in patients with locally advanced head-and-neck carcinoma (non-nasopharyngeal) treated by radiotherapy alone or combined radiochemotherapy in a randomized trial. Int J Radiat Oncol Biol Phys. 2004; 59(4): 1018–1026.
  5. Mendenhall WM, Mancuso AA, Strojan P, et al. Impact of primary tumor volume on local control after definitive radiotherapy for head and neck cancer. Head Neck. 2014; 36(9): 1363–1367.
  6. Studer G, Glanzmann C. Volumetric staging in oropharyngeal cancer patients treated with definitive IMRT. Oral Oncol. 2013; 49(3): 269–276.
  7. Studer G, Glanzmann C. Volumetric stratification of cT4 stage head and neck cancer. Strahlenther Onkol. 2013; 189(10): 867–873.
  8. Rutkowski T. The role of tumor volume in radiotherapy of patients with head and neck cancer. Radiat Oncol. 2014; 9: 23.
  9. Been MJ, Watkins J, Manz RM, et al. Tumor volume as a prognostic factor in oropharyngeal squamous cell carcinoma treated with primary radiotherapy. Laryngoscope. 2008; 118(8): 1377–1382.
  10. Johnson C, Thames H, Huang D, et al. The tumor voluem and clonogen number relationship: Tumor control predictions based upon tumor volume estimates derived from computed tomography. International Journal of Radiation Oncology*Biology*Physics. 1995; 33(2): 281–287.
  11. Dubben HH, Thames H, Beck-Bornholdt HP. Tumor volume: a basic and specific response predictor in radiotherapy. Radiotherapy and Oncology. 1998; 47(2): 167–174.
  12. Magee BJ, Logue JP, Swindell R, et al. Tumour size as a prognostic factor in carcinoma of the cervix: assessment by transrectal ultrasound. Br J Radiol. 1991; 64(765): 812–815.
  13. Tsang R, Fyles A, Kirkbride P, et al. Proliferation measurements with flow cytometry Tpot in cancer of the uterine cervix: Correlation between two laboratories and preliminary clinical results. International Journal of Radiation Oncology*Biology*Physics. 1995; 32(5): 1319–1329.
  14. Steel GG. The growth kinetics of Tumors. Clarendon Press, Oxford 1977.
  15. Brenner D. Dose, volume, and tumor-control predictions in radiotherapy. Int J Radiat Oncol Biol Phys. 1993; 26(1): 171–179.
  16. Fowler JF. Practical Time-dose evaluation: How to stop worrying and learn to love Linear-Quadratics. In: Levitts S, Purdy J, Perez J, Poortmans P. ed. Technical Basis of radiotherapy. Practical Clinical Heidelberg Application. Heidelberg; Springer, Berlin 2012: 3–31.
  17. Perez CA, Karanagh BD. Uterine cervix. w Perez and Brady’s Principles and Practice of Radiation Oncology 5th Eds. Lippincott, Williams and Wilkins 2014: 1532–1609.
  18. Weiss E, Richter S, Krauss T, et al. Conformal radiotherapy planning of cervix carcinoma: differences in the delineation of the clinical target volume. A comparison between gynaecologic and radiation oncologists. Radiother Oncol. 2003; 67(1): 87–95.
  19. Kavanagh B, Schefter T, Wu Q, et al. Clinical application of intensity-modulated radiotherapy for locally advanced cervical cancer. Seminars in Radiation Oncology. 2002; 12(3): 260–271.
  20. Girinsky T, Rey A, Roche B, et al. Overall treatment time in advanced cervical carcinomas: A critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys. 1993; 27(5): 1051–1056.
  21. Ito H, Kutuki S, Nishiguchi I, et al. Radiotherapy for cervical cancer with high-dose rate brachytherapy — correlation between tumor size, dose and failure. Radiother Oncol. 1994; 31(3): 240–247.

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