Vol 26, No 3 (2021)
Research paper
Published online: 2021-03-26

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Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality

José Antonio Solis12, Ilan Perrot Rosenberg12, Jorge Olivares12, Benjamin Tudela12, Gabriel Veillon12, Gabriel Lazcano12
Rep Pract Oncol Radiother 2021;26(3):360-366.

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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References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Bhtla N, Denny L. FIGO Cancer Report 2018: Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018; 143(Suppl. 2): 22–36.
  3. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000; 18(8): 1606–1613.
  4. Delgado G, Bundy BN, Fowler WC, et al. A prospective surgical pathological study of stage I squamous carcinoma of the cervix: A Gynecologic Oncology Group study. Gynecol Oncol. 1989; 35(3): 314–320.
  5. Delgado G, Bundy B, Zaino R, et al. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: A Gynecologic Oncology Group study. Gynecol Oncol. 1990; 38(3): 352–357.
  6. Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol. 1999; 73(2): 177–183.
  7. Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2006; 65(1): 169–176.
  8. Look KY, Rocereto TF. Relapse patterns in FIGO stage IB carcinoma of the cervix. Gynecol Oncol. 1990; 38(1): 114–120.
  9. Balaya V, Guani B, Magaud L, et al. Long-term oncological safety of sentinel lymph node biopsy in early-stage cervical cancer. J Clin Oncol. 2020; 38(15 (Suppl.)): 6006–6006.
  10. Ouldamer L, Marret H, Acker O, et al. Unusual localizations of sentinel lymph nodes in early stage cervical cancer: a review. Surg Oncol. 2012; 21(3): e153–e157.
  11. Ohara K, Tsunoda H, Satoh T, et al. Use of the small pelvic field instead of the classic whole pelvic field in postoperative radiotherapy for cervical cancer: reduction of adverse events. Int J Radiat Oncol Biol Phys. 2004; 60(1): 258–264.
  12. Kridelka FJ, Berg DO, Neuman M, et al. Adjuvant small field pelvic radiation for patients with high risk, stage IB lymph node negative cervix carcinoma after radical hysterectomy and pelvic lymph node dissection. A pilot study. Cancer. 1999; 86(10): 2059–2065.
  13. Hong JH, Tsai CS, Lai CH, et al. Postoperative low-pelvic irradiation for stage I-IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis. Int J Radiat Oncol Biol Phys. 2002; 53(5): 1284–1290.
  14. Yeo RMC, Chia YN, Namuduri RPD, et al. Tailoring adjuvant radiotherapy for stage IB-IIA node negative cervical carcinoma after radical hysterectomy and pelvic lymph node dissection using the GOG score. Gynecol Oncol. 2011; 123(2): 225–229.
  15. Luo HC, Lin GS, Liao SG, et al. Cervical cancer treated with reduced-volume intensity-modulated radiation therapy base on Sedlis criteria (NCCN VS RTOG). Br J Radiol. 2018; 91(1081): 20170398.
  16. Yuce Sari S, Guler OC, Gultekin M, et al. Adjuvant Small Pelvic Radiotherapy in Patients with Cervical Cancer Having Intermediate Risk Factors Only - Is It Sufficient? Oncol Res Treat. 2017; 40(9): 523–527.
  17. Perez CA, Brady LW. Acute Radiation Morbidity Scoring Criteria (RTOG). In: Perez CA, Brady LW. ed. Principles and practice of radiation oncology. 2nd ed. Lippincott, Philadelphia 1993: 51–53.
  18. Perez CA, Brady LW. Late Radiation Morbidity Scoring Criteria (RTOG, EORTC). In: Perez CA, Brady LW. ed. Principles and practice of radiation oncology. 2nd ed. Lippincott, Philadelphia 1993: 53–55.



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