title: Clinical outcomes in cervical cancer patients treated by FDG-PET/CT-based 3-dimensional planning for the first brachytherapy session.
abstract: The aim of the study was to evaluate the treatment outcomes in cervical cancer patients treated with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT)-guided 3-dimensional brachytherapy (3D-BT) planning for the first brachytherapy session.We retrospectively analyzed 87 patients with cervical cancer who received definitive radiotherapy (RT). Primary tumor size was ≤4 cm in 22 patients (25.3%), >4 cm and ≤6 cm in 45 patients (51.7%), and >6 cm in 20 patients (23.0%). The median total dose of external beam RT was 50.4 (50.4-60.4) Gy. FDG-PET/CT-guided 3D-BT with an iridium-192 source was performed. The clinical target volume (CTV) for 3D-BT included the entire cervix and the abnormal FDG-uptake with a 1-cm expansion. A planned total dose was 24 Gy at 4 Gy per insertion 3 times per week using a tandem and 2 ovoids.The mean D95 and D90 for the CTV were 73.4 (±5.9) Gy and 77.9 (±6.9) Gy, respectively (EQD2, α/β=10). The D2cc for the rectum and bladder was 374 (±97.4) cGy and 394 (±107.6) cGy per fraction, respectively. The EQD2 (α/β=3) for the D2cc was 74.5 (±12.4) Gy for the rectum and 77.3 (±14.6) Gy for the bladder. The median follow-up period was 40 (8-61) months. The 3-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 84.7%, 72.1%, and 89.2%, respectively. The 3-year LC rate was 100% for tumors ≤ 4 cm, 91.1% for tumors > 4 cm and ≤ 6 cm, and 70.5% for tumors > 6 cm (P = 0.014). Local failure developed in 9 patients. Three patients had local failures outside of the CTV. Grade 1, 2, and 3 rectal bleeding developed in 5, 4, and 2 patients, respectively. One patient experienced rectovaginal fistula.FDG-PET/CT-guided 3D-BT planning is a feasible approach, which showed favorable clinical outcomes.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Radiation Oncology, Kangbuk Samsung Hospital, Seoul, Korea Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Dongryul
authors.initials: D
authors.lastname: Oh
authors.forename: Seung Jae
authors.initials: SJ
authors.lastname: Huh
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Ju
authors.forename: Heerim
authors.initials: H
authors.lastname: Nam
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*