(P074) The Use of Stereotactic Body Radiotherapy in Lieu of Brachytherapy in Patients With Cervical or Endometrial Cancer

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

SBRT boost appears to be an effective and well-tolerated alternative treatment method for patients with gynecologic malignancies who cannot undergo brachytherapy. Target coverage and dose to organs at risk with SBRT appear to be comparable with those of brachytherapy. Acute toxicity is minimal. These initial clinical results substantiate the need for further evaluation of this treatment approach and its long-term efficacy and safety.

Nabila L. Waheed, DO, Michelle Ludwig, MD, PhD, Celestine Tung, MD, Marian Williams-Brown, MD, Creighton L. Edwards, MD, Concepcion Diaz-Arrastia, MD, Matthew L. Anderson, MD, PhD, Lois Ramondetta, MD, Timothy Wagner, MD, Joshua Asper, PA, Danny Tran, CMD, Umang Patel, MD, Mark Bonnen, MD; Department of Radiation Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine; Department of Gynecologic Oncology, UT MD Anderson Cancer Center

PURPOSE: To evaluate the use of stereotactic body radiation therapy (SBRT) as an alternative treatment method to brachytherapy in patients with cervical or endometrial carcinoma with anatomically difficult-to-implant tumor volumes or other contraindications to brachytherapy.

MATERIALS AND METHODS: A total of seven patients undergoing radiation therapy with curative intent for cervical or uterine cancer were identified after they had been deemed ineligible for brachytherapy due to unfavorable anatomy, including large tumor size, location, and/or prior hysterectomy. Patients diagnosed with either cervical (n = 5) or endometrial (n = 2) cancer were treated using 45–48.6 Gy external beam radiation to the pelvis +/− para-aortic lymph nodes. Either three-dimensional (3D) radiation or intensity-modulated radiotherapy (IMRT) was followed by Linac-based SBRT to the cervix or vaginal cuff at a dose of 5–6 Gy in five daily fractions to a total of 25–30 Gy. Median age was 52 years (range: 47–64 yr). The International Federation of Gynecology and Obstetrics (FIGO) stage was I (n = 1), II (n = 2), and IV (n = 1); the remaining three patients had vaginal cuff recurrence. All patients were simulated and treated after insertion of a Foley urinary catheter with manual bladder filling to a predetermined volume. Patients also underwent bowel preparation at the time of simulation and before each treatment fraction, and daily cone-beam image-guided radiotherapy (IGRT) was utilized. The dose-volume histograms for planning target volumes, as well as organs at risk, were all analyzed.

RESULTS: SBRT was well tolerated. No acute severe urinary or gastrointestinal toxicity > grade 2 was observed during treatment or up to 5 months posttreatment. Target volume of 95% gross tumor volume (GTV) coverage goal was > 95% (range: 95%–99%). D0.2cc to the bladder was kept at or below 90 Gy (range: 87.3–90 Gy). Total bladder D0.2cc contribution from SBRT for all five fractions was 20.5–40 Gy. D0.2cc to the rectum was kept at or below 75 Gy (range: 69–73.8 Gy). Total rectal D0.2cc contribution from SBRT for all five fractions was 13.1–23.8 Gy. No patient has had any sign of progression or local failure at follow-up thus far, with a median follow-up of 3 months.

CONCLUSION: SBRT boost appears to be an effective and well-tolerated alternative treatment method for patients with gynecologic malignancies who cannot undergo brachytherapy. Target coverage and dose to organs at risk with SBRT appear to be comparable with those of brachytherapy. Acute toxicity is minimal. These initial clinical results substantiate the need for further evaluation of this treatment approach and its long-term efficacy and safety.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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