Clinical results of radiation and chemoradiation therapy of locally advanced cervix cancer

Aim. This study reported clinical results of patients with locally advanced cervical cancer who were treated with conformal radiotherapy and three-dimensional (3D) image-guided adapted brachytherapy and combinations of cytotoxic drugs.

Material and methods. This study included 190 patients with cervical cancer stages IIb, IIIb, and IVb (metastases in para-aortic lymph nodes) during 2011–2015 treated with definitive conformal radiation or chemoradiotherapy, with total dose for D95 50 Gy for 25 fractions. 3D brachytherapy high dose rate planning and dose reporting followed the GEC-ESTRO recommendations. Prescribing dose per fraction for HR-CTV D90 was 7.5 Gy weekly 4 fractions. Total dose HR-CTV D90 40 Gy (EQD2). Average total dose for HR-CTV D90 from the course of radiation therapy was 95.0 ± 0.67 Gy (EQD2).

Following four groups of patient were evaluated: group 1 – radiation therapy (n = 72), group 2 – chemoradiation therapy with cisplatin (n = 40), group 3 – chemoradiation therapy with a combination of irinotecan + cisplatin, two courses of adjuvant chemotherapy (n = 39), group 4 – chemoradiation therapy with a combination of paclitaxel + cisplatin, two courses of adjuvant chemotherapy (n = 39). Clinical outcomes including local control (LC), cancer-specific survival (CSS), overall survival (OS), and toxicity were analyzed.

Results. Three-year OS and CSS in all these groups were as follows: group 1 – 88.4% ± 4.5% and 64.4% ± 7.3%, respectively; group 2 – 77.7% ± 7.6% and 77.5% ± 7.1%, respectively; group 3 – 69.8% ± 9.6% and 66.3% ± 8.9%, respectively; group 4 – 81.3% ± 6.4% and 62.1% ± 8.0%, respectively (p > 0.05). The use of chemoradiotherapy in the groups did not increase the 3-year OS in cervical cancer stage IIIb: in group 1 – 84.0% ± 7.5%, group 2 – 76.2% ± 9.4%; group 3 – 77.2% ± 9.1%, and group 4 – 84.9% ± 7.0% (p > 0.05). However, CSS was higher on the first year of observation in group 3 – 96.3% ± 3.6% compared with group 1 – 74.2% ± 7.5% (p = 0.049), with a 3-year observation – 75.7% ± 9.6% and 59.0% ± 11.4%, respectively (p = 0.31). Combined chemoradiation therapy in patients with cervical cancer increases the time of progression from 9.5 months (in groups 1 and 2) up to 19.4 months and 16.4 months (in groups 3 and 4), respectively (p = 0.05). A decrease in the number of local relapses during 3 years was obtained in groups 2 and 4 compared with group 1 (100% vs. 90.3%, p = 0.05). LC within 3 years among 190 patients was 94.7% ± 1.6%. Gastrointestinal early toxicity was noted higher in group 3 compared to groups 1, 2, and 4 (recites G2–3 – 25.7% vs. 5.6%, 5.0%, and 2.6%, respectively, p = 0.05). Late cystitis G2–3 is higher in groups 2, 3, 4 compared with group 1 (15.4% vs. 4.2%, p = 0.07).

Conclusion. The study showed high efficiency of treatment of patients with cervical cancer with the introduction in the clinic of modern technologies in radiation therapy with 3D visualization, as well as chemoradiotherapy programs with acceptable toxicity.