Table 4.
Literature overview
| Author and year of publication | Therapy seetings and study type | IMRT EBRT total dose/EBRT daily dose | Brachytherapy total dose | Number of patients treated with IMRT | FIGO Stage | Number of patients with positive pelvic lymph nodes | Number of patients with negative lymph nodes | Follow-up (median) in months | Total number of patients with disease relapse | Loco-regional failure | DFS/patient alive without sign of disease | OS/alive at last follow up | Acute gastrointestinal or genitourinary toxicites Gr 3 or greater | Chronic gastrointestinal or genitourinary toxicites Gr 3 or greater | Normal tissue planning constraints |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gerszten et al., [23] | Definitive, extended field IMRT, retrospective | 45 Gy and 55 Gy to involved nodes | 25 Gy/5 Gy | 22 | IB-IIIB | 9 (receiving nodal boost) 2 positive on surgical staging | 11 | No data | No data | No data | No data | No data | 0 | Not evaluated | rectal maximum dose: 54 Gy with no more than 40 % of the rectal volume receiving 40 Gy; bladder maximum dose 54 Gy with no more than 50 % at 40 Gy; small bowel maximum 50 Gy with no more than 35 % of small bowel receiving 35 Gy. |
| Kidd et al., [6] | Definitive 18 FDG PET based IMRT, retrospective comparison with non-IMRT radiochemotherapy | 50 Gy to whole pelvis and additional 20 Gy to central region (cervix) | 6 weekly fraction of 6.5 Gy HDR | 135 | IBI-IVA | 41 (30.4 %) | 68 (50.4 %) | 22 (range, 5–47 months) | 39 | 11 (8.1 %) | 91 (67.4 %) pts | No data | No data | 8 (6 %) | <40 % of bowel to receive 30 Gy, <40 % of rectum to receive 40 Gy, <40 % of pelvic bones to receive 40 Gy, and <40 % of femoral heads to receive 30 Gy. |
| Hasselle et al., [25] | Definitive IMRT in 81 patients. Retrospective multicentric study. | median 45 Gy (range: 39.6 - 50.4 Gy)/1.8 Gy | LDR 35 to 40 Gy; 5 HDR fractions to 27.5 to 30 Gy | 111 (22 postop, 8 with consecutive surgery) | I–IVA | No data | No data | 26.6 (range, 5.4–99.0 months) | No data | The 3-year pelvic failure rate - 29.2 % | 69 % (95 % CI, 59–81 %) | 78 % (95 % confidence interval [CI], 68–88 %) | 2 % (95 % CI, 0–7 %) | 7 % (95 % CI, 2–13 %) | rectum: maximum dose < 50 Gy; bowel V45 < 250 mL, pelvic BM V20 < 75 %, V10 < 90 %; bladder: as low as reasonably achievable |
| Chen et al., [26] | Definitive, IMRT, retrospective | 45–54 Gy, (54–60 nodes simultan boost) | HDR 20 – 33.5 Gy/4–6 Gy/Fraction 2 x Week | 109 | IB2 - IVA | 14 | 82 | 32.5 for survival pts (5–75) | 5 (4.6 %) locoregional only; 14(12.8 %) distant only; 29 (26.6 %) in total; | 21.9 % at 3 year | 67.6 % at 3 year | 78.2 % at 3 year | 3 pts (GI Only) | 5 (4.6 %) GI 7 (6.4 %) GU | rectum: V30 < 50 %; small bowel: V30 < 15 %; |
| Du XL et al., [29] | Definitive RT-CH. Comparison of reduced field IMRT with conventional EBRT. | 30 Gy to whole pelvis with additional boost of 30 Gy to lymphatic drainage region as well as paracervix and parametrium. | HDR 10–30 Gy/5–6 Gy SD | 60 | IIB–IIIB | No data | No data | 7 months (range, 6 - 68 months) | 64.90 % | No data | 64.9 % PFS at 5 y | 82.5 % at 3 y; 71.2 % at 5 y | 7 | 0 | No data |
| Gandhi et al. [8] | Definitive radio chemotherapy. Nonblind, prospective, randomized, phase II trial. Comparison with whole pelvis conventional radiotherapy | 50.4 Gy/1.8 Gy | 21 Gy/7 Gy SD | 22 | IIB-IIIB | No data | No data | 21.6 months (range, 7.7-34.4 months). | 5 (22.7 %) | 2 (9.1 %) | 60 % at 27 months | 85.7 % at 27 months | 2 | 0 | small bowel: volume receiving 40 Gy (V40) <32 %, maximum dose <50 Gy; rectum: V40 < 40 %, maximum dose <50 Gy; bladder: V40 < 40 %, maximal dose < 50 Gy |
| Jensen LG et al., [31] | Definitive, extended-field intensity-modulated radiotherapy | 45 to 50.4, median boost dose to parametrian: 9 Gy or pelvic LN 10 Gy in 16 pts, PA boost of median 10.4 Gy in 6 pts | LDR 35 to 40 Gy 1 or 2 x; HDR 19.8 to 30 3 to 5 x | 21 | IB1 - IIIB | 14 patients had paraaortic LN and 20 pelvic LN | 0 | 22 (range, 12 to 56 months) for survived patients | 11 | No data | 42.9 % (95 % CI, 26.2 % Y70.2 %). At 11 months | 59.7 % (95 % confidence interval [CI], 41.2 % Y86.4 %) at 11 months | 4(19 %) | 2 (9.5 %) | rectum: maximum dose < 50 Gy; bowel: V45 < 250 cm3; bladder: as low as reasonably achievable. |
| Cihoric et al. [11] | Definitive dose escalated IMRT, retrospective | 50.4 to whole pelvis, 5.4 to 9 Gy boost to central disease, 62 Gy to lymph nodes | HDR TD 15–18 Gy with 4–6.5 Gy SD | 39 | IB2 to IVA | 24 (61.5 %) | 15 | 36 (3–71 months) | 14 (35.9 %) | 9 (23.1 %) patient with pelvic failure; LRFS was 55.2 ± 4.4 months | 25 (64.1 %). The mean DFS: 47.2 ± 4.9 months | Mean OS time for the entire cohort: 61.1 ± 3.5 months | 2 (5.2 %) | 2 (5.2 %) | 60 % of rectum < 50 Gy, 35 % of bowel < 35Gy, 50 % of bladder < 50 Gy and 10 % of the femoral heads < 50 Gy. |