Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer
Received 20 March 2009; received in revised form 20 November 2009; accepted 17 December 2009. published online 15 January 2010.
Abstract
Purpose
To evaluate outcome of radiotherapy for locally recurrent cervical and endometrial cancer.
Materials and methods
Nineteen patients were treated for a locally recurrent cervical (n=12) or endometrial (n=7) cancer median 26months after initial surgery (n=18) or radiotherapy (n=1). The whole pelvis was irradiated with 50Gy conventionally fractionated radiotherapy (n=16). Because of large size of the recurrent cancer (median 4.5cm) and peripheral location (n=12), stereotactic body radiotherapy (SBRT; median 3 fractions of 5Gy to 65%) was used for local dose escalation instead of (n=16) or combined with (n=3) vaginal brachytherapy.
Results
After median follow-up of 22months, 3-year overall survival was 34% with systemic progression the leading cause of death (7/10). Median time to systemic progression was 16months. Three local recurrences resulted in a local control rate of 81% at 3years. No correlation between survival, systemic or local control and any patient or treatment characteristic was observed. The rate of late toxicity>grade II was 25% at 3years: two patients developed a grade IV intestino-vaginal fistula and one patient suffered from a grade IV small bowel ileus.
Conclusion
Image-guided SBRT for local dose escalation resulted in high rates of local control but was associated with significant late toxicity.
ABSTRACT