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European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.
Survival and toxicity of radical radiotherapy (with or without brachytherapy) for FIGO Stage I and II cervical cancer: a mono-institutional analysis
L. Bandera1,*, B. La Face1, C. Antonioli1, M. Galelli2, B. Ghedi2, A. Fiume2, M. Buglione1, S. M. Magrini1, E. Sartori3
1 Istituto del Radio O. Alberti, Department of Radiation Oncology, Spedali Civili Hospital and Brescia University, Brescia
2 Department of Medical Physics, Spedali Civili Hospital, Brescia
3 Department of Obstetrics and Gynecology, Spedali Civili and Brescia University, Brescia (Italy)
Eur. J. Gynaecol. Oncol. 2014, 35(2), 121–127; https://doi.org/10.12892/ejgo24152014
Published: 10 April 2014
Purpose of investigation: To add to the existing outcome data regarding radical radiotherapy (RT) for FIGO Stage I and II cervical cancer in a mono-institutional series and to evaluate the cost-benefit ratio of the addition of brachytherapy (BRA) to external-beam radiotherapy (EBRT). Materials and Methods: The authors report on 240 patients (pts) with FIGO Stage I and II cervical cancer, consecutively treated with radical RT from 1990 through 2009 at the Istituto del Radio “O. Alberti” (EBRT alone, 32, EBRT and BRA, 189, BRA alone, 19). BRA was delivered with low dose rate (LDR, 133.64%) until 2003 and then with high dose rate (HDR, 75.36%). RT was associated with concomitant chemotherapy (CHT), mainly weekly cisplatin 40 mg/m2, in 87 pts, mostly after 2000. The Chi-square test was used to compare the different variables, the Log-Rank test to compare the actuarial survival values, and the Cox-model for the multivariate analysis. Results: Five-year actuarial overall survival (OS) equalled 65%, disease specific survival (DSS) 77%. Regardless of disease stage, better DSS was evident in pts treated with EBRT and BRA compared with those treated with EBRT alone (82% and 58% respectively, p = 0.005); pts treated with concomitant CHT (dose intensity ≥ 50%) and higher RT doses (RT cumulative EQD2 ≥ 75 Gy) obtained better DSS. Complete response (CR) rate approached 88.4% (206/233 evaluable pts) and more than half of the subsequent failures (21/36) were in distant sites. Older patients and those given BRA had better OS and DSS, while BRA dose rate did not result related with these outcomes. Chronic G3/G4 toxicity involved more frequently the intestinal/rectal tract than other organs at risk. Rectal and vaginal serious chronic sequelae developed mainly in pts treated with EBRT and BRA and suggest the need for more advanced treatment techniques. Conclusions: the present mono-institutional analysis confirms the efficacy of radical RT for the treatment of cervical cancer and provides support to the role of BRA to obtain better outcomes. An effort to reduce long term toxicity of the treatment is needed.