Intensity-Modulated Radiotherapy with Concurrent Chemotherapy for Elder Cervical Cancers: A Comparison of Clinical Outcomes with Conventional Radiotherapy

SummaryBackgroundThe goal of this report was to compare clinical outcomes for elderly patients with cervical cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy (IM-CCRT) or two-dimensional radiotherapy (2D-CCRT).MethodsSixty patients older than 75 years were treated with CCRT (30 with 2D-CCRT, and 30 with IM-CCRT) in Mackay Memorial Hospital, Taipei, Taiwan with Eastern Cooperative Oncology Group performance status 0-1. Retrospectively, treatment toxicities were graded weekly according to the NCI (National Cancer Institute) Common Toxicity Criteria version 3.0 and RTOG (Radiation Therapy Oncology Group) criteria. The Kaplan and Meier method compared with the log-rank test was used for disease-free survival (DFS) and overall survival (OS).ResultsThe median follow up duration of all patients was 41.7 months (range, 1-101 months). There were no statistical differences in histological type, The International Federation of Gynecology and Obstetrics stage, performance status, and cycles of chemotherapy between these two groups (p = 0.554, p = 0.793, p = 0.796, and p = 0.161, respectively). The mean treatment duration was significantly longer for the IM-CCRT-group (66.1 days vs. 51.7 days, p < 0.05). The local recurrence and distant metastasis were significantly lower for the IM-CCRT-group (p = 0.023 and p = 0.006, respectively). Acute gastrointestinal toxicities tended to be more significant in patients who received IM-CCRT (2D-CCRT vs. IM-CCRT: Grade 2 = 23% vs. 27%, Grade 3 = 23% vs. 37%, p = 0.001, respectively). The 3-year actuarial OS of the 2D-CCRT-group and IM-CCRT-group were 70.2% and 78.8%, respectively (p = 0.689). The 3-year DFS of the 2D-CCRT-group and IM-CCRT-group were 73.4% and 100%, respectively (p = 0.014).ConclusionThe use of IM-CCRT was associated with equivalent compliance and encouraging preliminary clinical results compared to 2D-CCRT.