NCI Workshop on Advanced Technologies in Radiation Oncology: Cervix. December 1, 2006 David Gaffney MDPhD Huntsman Cancer Hospital University of Utah. Radiotherapy for Cervix Cancer: An Important Paradigm . Cure very large tumors with RT alone Local control correlates with survival
December 1, 2006
David Gaffney MDPhD
Huntsman Cancer Hospital
University of Utah
5% of patients received chemotherapy
Logsdon and Eifel IJROBP 43(4):763, 1999.
Pt A 85 Gy,
VSD 110 Gy,
Cervical os 150-200 Gy
Grigsby et al IJROBP 59(3):706, 2004
5/132 with PET + Pelvic LN’s failed. 1/33 with PET + PA LN’s failed.
“Lymph node recurrence as the only site of failure occurred in <2% of our patients…To resect or not to resect enlarged lymph nodes or to increase the irradiation dose to toxic levels in all patients is not the clinically relevant issue.“
Sequential FDG-PET brachytherapy
treatment planning in carcinoma of the cervix
Lin et al IJROBP 63:1494, 2005
Rapid involution and mobility of carcinoma
of the cervix, Lee et al IJROBP 58(2):625, 2004
SUV t1/2 20 days or 25 Gy
t1/2 21 days or 31 Gy
RFS by PET
Lee et al IJROBP 2004
No Randomized Trials!
Cervix: IMRT/IGRT complications No Randomized Trials!1.Promising Single Institutional Data -AJ Mundt MD U of Chicago/UCSD -bone marrow sparing -less GI and hemetologic toxicity2. Prospective RTOG phase II trial: 0418
Neutron therapy in cervical cancer: results of a phase III RTOG Study. Maor MH et al IJROBP 14:885, 1988
-(50 Gy in 25 fractions over 5 weeks plus intracavitary applications or external-beam boost) or mixed-beam radiotherapy (2 fractions a week of neutrons, 3 fractions a week of photons to a total RBE-adjusted dose of 50 Gy plus intracavitary applications or external mixed-beam boost).
-The % of patients undergoing intracavitary applications was 50% on mixed beam and 75% on photons (p < 0.01).
-Tumor clearance was 52% and 72% for mixed beam and photons, respectively (p<0.03).
-Median survivals were 1.9 years on mixed beam and 2.3 years on photons.
-Severe complications occurred in 19% and 11% in mixed beam and photons respectively (p<0.13). The inferior outcome with neutron therapy in this study may have resulted from the use of horizontal neutron beams of varying energy and penetration.
Promising phase II experience at Univ of Kentucky by
Maruyama et al.
Sources now at Tufts.
Dimoupoulos et al IJROBP