Anne De La Rochefordiere, Abstract Co-Author: Nothing to Disclose

Maura Campitelli MD, Presenter: Nothing to Disclose

Chantal Dauphinot, Abstract Co-Author: Nothing to Disclose

Corine Plancher, Abstract Co-Author: Nothing to Disclose

Severine Alran, Abstract Co-Author: Nothing to Disclose

Virginie Fourchotte, Abstract Co-Author: Nothing to Disclose

Philippe Beuzeboc, Abstract Co-Author: Nothing to Disclose

Peter Petrow MD, Abstract Co-Author: Nothing to Disclose

Alain Fourquet, Abstract Co-Author: Nothing to Disclose

Purpose/Objective(s): To describe acute toxicity in patients treated with intensity-modulated whole pelvic radiation therapy (IM-WPRT) for cervical cancer. Materials/Methods: 12 patients (stage FIGO IB2 to IV), median age 48 years (range 39-74), were treated at Institut Curie between September 2006 and September 2008. 8 patients had radiologically positive lymph nodes, 6 in the pelvis and 2 in the paraaortic regions. Each patient underwent a planning CT scan and MRI in the supine position. Target volumes and organs at risk were contoured on matched images. The CTV consisted of the uterus/cervix, parametrial tissues, the whole vagina and the regional lymph nodes. The PTV was defined as the CTV with a 1-cm margin. Small bowel, bladder and rectum were evaluated for toxicity. 4 patients were treated with pre-operative RT to a dose of 36 Gy, while 8 patients received exclusive radiotherapy, to a dose of 45 Gy. Eight patients also received a pelvic boost (median dose 53 Gy [range 42-65]. Two patients received paraaortic irradiation of 45 Gy with a boost up to 55 Gy and 61.4 Gy. 10 patients had concurrent platinum-based chemotherapy while 2 had neo-adjuvant chemotherapy. 9 patients also underwent LDR brachytherapy. Patients were assessed weekly for acute toxicity. Toxicity was evaluated according to CTCv3. Results: All patients completed the prescribed course of IM-WPRT. A 6-day radiotherapy break was required for 1 patient for grade 3 skin toxicity. The final week of chemotherapy was held in 3 patients; 1 patient with Sj”gren?s syndrome only received 2 out of 4 prescribed cycles. No patient suffered proctitis. Grade 2 acute toxicity was the following: genitourinary in 1 patient, gastrointestinal in 2 patients, cutaneous in 1 patient, haematological in 2 patients. Grade 3 acute toxicities occurred in 3 patients: 1 gastrointestinal, 1 haematological and 1 cutaneous. Conclusions: Our initial clinical evaluation indicated that acute morbidity of IMRT was acceptable, considering the toxic nature of combined radiochemotherapy. IMRT allowed for dose escalation to involved pelvic and paraaortic nodes. We had previously shown, in a dosimetric comparison study, that IMRT was superior to 3D-CRT in sparing the normal tissues. The fact that only one patient experienced gastrointestinal grade 3 acute toxicity is most likely due to a reduction in dose to small bowel achieved with IMRT. A prospective trial is needed with a larger number of patients to clearly evaluate the benefit of IMRT in gynaecologic malignancies.

De La Rochefordiere, A, Campitelli, M, Dauphinot, C, Plancher, C, Alran, S, Fourchotte, V, Beuzeboc, P, Petrow, P, Fourquet, A, Preliminary Evaluation of Acute Toxicity in Cervical Cancer Patients Treated with Intensity Modulated Whole Pelvic Radiation Therapy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8500877.html