title: Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer.
abstract: OBJECTIVE
  This study aimed to evaluate the toxicity and clinical outcomes for cervical cancer patients treated definitively with intensity-modulated radiation therapy (IMRT) compared with non-IMRT treatment.
  
  
  METHODS
  This prospective cohort study included 452 patients with newly diagnosed cervical cancer treated with curative intent (135 IMRT and 317 non-IMRT). Treatment involved external irradiation and brachytherapy, and 85% of patients received concurrent chemotherapy. All IMRT patients underwent an F-18 fluorodeoxyglucose positron emission tomography (FDG-PET/CT) simulation. A 3-month post-therapy PET was obtained to evaluate treatment response. Toxicity was scored by the Common Terminology Criteria for Adverse Events Version 3.0.
  
  
  RESULTS
  The IMRT and non-IMRT groups had similar stage distribution and histology. For all patients, the post-therapy FDG-PET response correlated with overall recurrence risk (p < 0.0001) and cause-specific survival (p < 0.0001). Post-treatment FDG-PET findings were not significantly different between the IMRT and non-IMRT patients (p = 0.9774). The mean follow-up for all patients alive at the time of last follow-up was 52 months (72 months non-IMRT, 22 months IMRT). At last follow-up, 178 patients (39 IMRT, 139 non-IMRT) had developed a recurrence. The difference in recurrence-free survival between the two groups did not reach statistical significance (p = 0.0738), although the IMRT group showed better overall and cause-specific survivals (p < 0.0001). Of the patients, 62 patients (8 IMRT and 54 non-IMRT) developed Grade 3 or greater bowel or bladder complications, and by cumulative hazard function analysis the risk was significantly less for patients treated with IMRT (p = 0.0351).
  
  
  CONCLUSIONS
  Cervical cancer patients treated with FDG-PET/CT-guided IMRT have improved survival and less treatment-related toxicity compared with patients treated with non-IMRT radiotherapy.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Kidd
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.forename: Farrokh
authors.initials: F
authors.lastname: Dehdashti
authors.forename: Janet S
authors.initials: JS
authors.lastname: Rader
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Powell
authors.forename: Perry W
authors.initials: PW
authors.lastname: Grigsby
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18