Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer

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.

Keywords: Stereotactic body radiotherapy, Local recurrence, Cervical cancer, Endometrial cancer, Image-guided radiotherapy