295P - A prospective study of dose escalated simultaneous integrated boost in node-positive cervical cancer

Background

Volumetric arc therapy (VMAT) with Simultaneous Integrated Boost (SIB) allows radiotherapy dose escalation to the region of involved nodes also reducing toxicity in node-positive patients of cervical cancer. Aim of this study was to evaluate the early outcome and acute toxicity with chemo-radiation usingVMAT with SIB in patients with locally advanced cervical cancer.

Methods

Thirty-three newly diagnosed cases of carcinoma cervix having Positron emission tomography (PET) positive pelvic/para-aortic nodes were included after obtaining a written informed consent. The complete clinical assessment and staging was performed. All patients were treated by VMAT with SIB technique to the dose of 50.4Gy to the primary site with draining nodes and 58.8Gy to PET positive nodes in 28 fractions followed by HDR brachytherapy boost of 7Gy in three fractions. Concurrent cisplatin at the dose of 40mg/m2 was administered on weekly basis during External beam radiotherapy. Acute toxicity was assessed according to the RTOG Acute Radiation Morbidity scoring criteria. Post treatment response was assessed by clinical examination and PET-CT /CECT scans at 3months.

Results

Median age was 55 years(range 35-70). The mean tumor size was 5.7cm (range 3.5-9) with 90% patients having disease more than 4cm. Median Standardized uptake value maximum in PET at primary tumor and LN was 17.3 and 8.7 respectively. Pelvic node only was seen in 23(69.6%) patients while Para-aortic node was involved in ten. Bladder and rectum invasion was seen in four and two patients respectively.Twenty-six (79%) patients received four or more cycles of concurrent Cisplatin. The median overall treatment time was 62 days. Response assessment at 3months showed complete response in 27 patients (82%), partial response in four while progressive disease in two patients. Maximum grade of toxicity at 3 months in skin, gastrointestinal, and hematological was grade I whereas one patient had grade III genitourinary toxicity. At last follow up, 30 patients were alive while three patients died; two deaths due to disease.

Conclusions

VMAT with SIB to involved nodes to higher doses results in effective early loco-regional control with acceptable acute toxicities.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

R. Mishra.

Funding

Institute of Eminence, Banaras Hindu University, Varanasi.

Disclosure

All authors have declared no conflicts of interest.