title: Hypofractionated extracranial stereotactic radiotherapy boost for gynecologic tumors: a promising alternative to high-dose rate brachytherapy.
abstract: The purpose of this study is to report toxicity and outcome results in patients with gynaecological tumours treated with a final boost using extra-cranial stereotactic radiotherapy (SRT) with a linac-based micro-multileaf collimator technique as an alternative to high-dose rate brachytherapy (HDR-BT). Since January 2002, 26 patients with either endometrial (n = 17) or cervical (n = 9) cancer were treated according to this protocol: 45-50.4 Gy external radiotherapy (RT) to the pelvic +/- para-aortic regions followed by a final SRT boost of 2 x 7 Gy to the vaginal vault (4-7 day interval between fractions). Median age was 62 years (37-74 range). Fifteen patients were diagnosed with adenocarcinoma, 7 with squamous-cell carcinoma, and 4 with sarcoma. FIGO stage I (n = 17), stage II (n = 7), and stage III (n = 2). Toxicity was scored according to RTOG/EORTC criteria. No severe (> grade-3) acute urinary or low-gastrointestinal (GI) toxicity was observed during treatment and up to 3 months after treatment completion. Moderate (grade < or = 3) acute urinary or low-GI toxicity was observed in 23% and 35% of patients, respectively. After a median follow-up of 47 months (4-77, range), late urinary, low-GI, and sexual > or = grade-2 (worst score) has been reported in 4%, 12% and 29.4% of patients, respectively. The 3-year loco-regional failure-free and overall survival rates were 96% and 95%, respectively. Preliminary results on feasibility, tolerance, and outcome with SRT are encouraging and may be considered a sound alternative to HDR-BT for gynecologic tumors.
authors.affiliation: Servei de Radio-oncologia, Institut Oncològic Teknon, Vilana 12, 08022 Barcelona-E, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Jorcano
authors.forename: Meritxell
authors.initials: M
authors.lastname: Molla
authors.forename: Lluís
authors.initials: L
authors.lastname: Escude
authors.forename: Sergi
authors.initials: S
authors.lastname: Sanz
authors.forename: Alberto
authors.initials: A
authors.lastname: Hidalgo
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Toscas
authors.forename: Dolors
authors.initials: D
authors.lastname: Linero
authors.forename: Raymond
authors.initials: R
authors.lastname: Miralbell
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage