title: Intensity-modulated arc therapy with cisplatin as neo-adjuvant treatment for primary irresectable cervical cancer. Toxicity, tumour response and outcome.
abstract: OBJECTIVE
  The goal of this work was to evaluate the feasibility and outcome of intensity-modulated arc therapy ± cisplatin (IMAT ± C) followed by hysterectomy for locally advanced cervical cancer.
  
  
  METHODS
  A total of 30 patients were included in the study. The primary tumour and PET-positive lymph node(s) received a simultaneous integrated boost. Four weeks after IMAT ± C treatment, response was evaluated. Resection consisted of hysterectomy with or without lymphadenectomy. Tumour response, acute and late radiation toxicity, postoperative morbidity and outcome were evaluated.
  
  
  RESULTS
  All hysterectomy specimens were macroscopically tumour-free with negative resection margins; pathological complete response was 40%. In 2 patients, one resected lymph node was positive. There was no excess in postoperative morbidity. Apart from two grade 3 hematologic toxicities, no grade 3 or 4 acute radiation toxicity was observed. No grade 3, 1 grade 4 (4%) intestinal, and 4 grade 3 (14%) urinary late toxicities were observed. The 2-year local and regional control rates were 96% and 100%, respectively. The 2-year distant control rate was 92%. Actuarial 2-year progression free survival rate was 89%. Actuarial 1- and 2-year overall survival rates were 96% and 91%, while 3-year overall survival was 84%.
  
  
  CONCLUSIONS
  Surgery after IMAT ± C is feasible with low postoperative morbidity and radiation toxicity. Local, regional, distant control and survival rates are promising.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. Katrien.Vandecasteele@uzgent.be
authors.forename: K
authors.initials: K
authors.lastname: Vandecasteele
authors.forename: A
authors.initials: A
authors.lastname: Makar
authors.forename: R
authors.initials: R
authors.lastname: Van den Broecke
authors.forename: L
authors.initials: L
authors.lastname: Delrue
authors.forename: H
authors.initials: H
authors.lastname: Denys
authors.forename: K
authors.initials: K
authors.lastname: Lambein
authors.forename: B
authors.initials: B
authors.lastname: Lambert
authors.forename: M
authors.initials: M
authors.lastname: van Eijkeren
authors.forename: P
authors.initials: P
authors.lastname: Tummers
authors.forename: G
authors.initials: G
authors.lastname: De Meerleer
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D020266:Radiotherapy, Conformal / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D002945:Cisplatin