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Hypofractionated Extracranial Stereotactic Radiotherapy Boost For Gynecologic Tumors: A Promising Alternative To High-Dose Rate Brachytherapy (509-514)

The purpose of this study is to report toxicity and outcome results in patients with gynaecological tumours treated with a final boost using extra-cranial stereotactic radiotherapy (SRT) with a linac-based micro-multileaf collimator technique as an alternative to high-dose rate brachytherapy (HDR-BT). Since January 2002, 26 patients with either endometrial (n = 17) or cervical (n = 9) cancer were treated according to this protocol: 45-50.4 Gy external radiotherapy (RT) to the pelvic ± para-aortic regions followed by a final SRT boost of 2 x 7 Gy to the vaginal vault (4-7 day interval between fractions). Median age was 62 years (37-74 range). Fifteen patients were diagnosed with adenocarcinoma, 7 with squamous-cell carcinoma, and 4 with sarcoma. FIGO stage I (n = 17), stage II (n = 7), and stage III (n = 2). Toxicity was scored according to RTOG/EORTC criteria.

No severe (>grade-3) acute urinary or low-gastrointestinal (GI) toxicity was observed during treatment and up to 3 months after treatment completion. Moderate (grade ≤ 3) acute urinary or low-GI toxicity was observed in 23% and 35% of patients, respectively. After a median follow-up of 47 months (4-77, range), late urinary, low-GI, and sexual ≥grade-2 (worst score) has been reported in 4%, 12% and 29.4% of patients, respectively. The 3-year loco-regional failure-free and overall survival rates were 96% and 95%, respectively. Preliminary results on feasibility, tolerance, and outcome with SRT are encouraging and may be considered a sound alternative to HDR-BT for gynecologic tumors.

Key words: Extracranial stereotactic radiotherapy; cervix cancer; endometrial adeno­carcinoma; micromultileaf collimator; high-dose rate brachytherapy.




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TCRT October 2010

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Volume 9
No. 5 (431-538)
October 2010
ISSN 1533-0338

Sandra Jorcano, M.D.1
Meritxell Mollà, M.D.1
Lluís Escudé, D.Sc.1
Sergi Sanz, D.Sc.2
Alberto Hidalgo, M.D.3
Jose Ignacio Toscas, M.D.1
Dolors Linero, D.Sc.1
Raymond Miralbell, M.D.1,4,*

1Servei de Radio-oncologia, Institut Oncològic Teknon, Vilana 12, 08022 Barcelona-E, Spain
2Statistics Department, Barcelona Centre for International Health Research. Villaroel 170, 08036 Barcelona-E, Spain
3Servei de Radiodiagnostic, Centro Médico Teknon, Vilana 12, 08022 Barcelona-E, Spain
4Service de Radio-oncologie, Hôpitaux Universitaires, Rue Micheli-du-Crest 24. 1211 Genève-CH, Switzerland

raymond.miralbell@hcuge.ch