IMR Press / EJGO / Volume 41 / Issue 5 / DOI: 10.31083/j.ejgo.2020.05.5453
Open Access Original Research
Simultaneous Integrated Intensity Modulated Radiotherapy Boost for Gynecological Cancer when Brachytherapy is not an Option
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1 SBU Trabzon Kanuni Training and Research Hospital. Dept of Radiation Oncology. Trabzon, Turkey
2 Gulhane Training and Research Hospital. Department of Radiation Oncology Ankara, Turkey
Eur. J. Gynaecol. Oncol. 2020, 41(5), 720–725;
Submitted: 26 December 2019 | Accepted: 23 July 2020 | Published: 15 October 2020

Objective: Brachytherapy (BT) lowers the risk of recurrence and improves the survival rate when used after external beam radiotherapy (EBRT) in cervical cancers. In endometrial cancers vaginal cuff BT lowers the risk of vaginal recurrence. New treatment methods have been investigated since BT is not an option for some patients mainly due to difficulties in the placement of BT applicators. Simultaneous integrated boost (SIB) has recently been investigated as an alternative modality in patients when BT is not suitable after EBRT. Materials and Methods: Five patients with cervical cancer and four patients with endometrial cancer were treated with SIB IMRT. In the five cervical cancer patients SIB treatment volumes were given a 74 Gy dose in 2,54 Gy fractions and common iliac and presacral lymphatic lymph node volumes were given 50,4 Gy in 1,74 Gy fractions. In the four patients with endometrial cancer the vagina and paravaginal-parametrial regions received a dose of 60 Gy in 2,3 Gy fractions using a 10 mm margin while a dose of 45 Gy in 1,73 fractions was administered to common iliac, external-internal iliac and obturator lymph nodes. Results: The five patients with the diagnosis of inoperable cervical cancer remained in complete remission (CR) through a median follow-up of 45 months (18-78 months) with a local control (LC) rate of 100%. Acute side effects were seen in 2 patients with cervical cancer and in 2 patients with endometrial cancer. Late side effects were observed in one patient in each of the cervical and endometrial cancer groups. Discussion: SIB-IMRT is an alternative treatment option for patients with cervical or endometrial cancer. Although this pilot study describes a limited number of patients it does suggest long term favorable results can be obtained with this method.

Cervical cancer
Endometrial cancer
Figure 1.
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