Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas
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Masaharu Hata1,2, Izumi Koike2, Etsuko Miyagi3,4, Reiko Numazaki4,5, Mikiko Asai-Sato4, Hisashi Kaizu2, Yuki Mukai2, Shoko Takano2, Eiko Ito2, Madoka Sugiura2 and Tomio Inoue2
1Division of Radiation Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
2Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
3Division of Gynecologic Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
4Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
5Department of Obstetrics and Gynecology, Yokohama Minami Kyousai Hospital, Yokohama, Kanagawa, Japan
Masaharu Hata, email: [email protected]
Keywords: cervical cancer; radiation therapy; stage IVA; uterine cervix; vesicovaginal fistula
Abbreviations: Biological effective dose, BED; high-dose-rate, HDR; computed tomography, CT; Radiation Therapy Oncology Group, RTOG
Received: September 11, 2017 Accepted: October 27, 2017 Published: December 01, 2017
Purpose: To evaluate the safety and efficacy of radiation therapy for stage IVA uterine cervical cancer and to identify an optimal radiation regimen.
Results: Seventeen of the 28 patients developed recurrence after radiation therapy (local recurrence in 10 and distant metastasis in 12). The local control and distant metastasis-free rates at 3 years in all patients were 61% and 49%, respectively. Fourteen patients died after radiation therapy, and all but 2 died of tumor progression. The disease-free, cause-specific, and overall survival rates at 3 years in all patients were 32%, 49%, and 45%, respectively, and the estimated median survival time was 32 months. Tumor size (P = 0.007) and involvement in the lower third of vagina (P = 0.006) were significant prognostic factors for local control. Older age (P = 0.018) and performance status (P = 0.020) were significant prognostic factors for distant metastasis. The presence of hydronephrosis was the sole significant prognostic factor for survival (P = 0.026). Only 2 patients developed grade 3 late toxicities (vesicovaginal fistula and radiation proctitis, respectively).
Materials and Methods: Twenty-eight patients with stage IVA uterine cervical cancer received radiation therapy. All patients initially received external pelvic irradiation at a median dose of 50.4 Gy in 28 fractions. Twenty patients also received high-dose-rate intracavitary brachytherapy at a median dose of 22 Gy in 4 fractions. These fraction sizes were lower than conventional sizes. The total median dose for all 28 patients was 68.7 Gy.
Conclusions: Radiation therapy is safe and effective for treatment of stage IVA uterine cervical cancer. The reduced radiation dose per fraction may contribute to the prevention of vesicovaginal fistula formation.
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