RESUMO
BACKGROUND: To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity. METHODS: Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment. RESULTS: Mean age was 46 (30-63) and 47 years (33-67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I-II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I-III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity. CONCLUSION: VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT "Box". We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT.
Assuntos
Carcinoma/terapia , Quimiorradioterapia/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Carcinoma/epidemiologia , Carcinoma/patologia , Quimiorradioterapia/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioterapia Conformacional/efeitos adversos , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologiaRESUMO
PURPOSE: To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival. METHODS/PATIENTS: From 1979-2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan-Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy. RESULTS: Patients' OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002). CONCLUSIONS: GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.