Comparing dosimetric and cancer control outcomes after intensity‑modulated radiation therapy and tomotherapy for advanced cervical cancer

Li,Dapeng; Wang,Dandan; Feng,Shuai; Chen,Quancai; Sheng,Xiugui; Jia,Jue; Yan,Xiaohui; Zhu,Jian; Yin,Yueju

doi:10.3892/ol.2022.13359

Comparing dosimetric and cancer control outcomes after intensity‑modulated radiation therapy and tomotherapy for advanced cervical cancer

Authors:
- Dapeng Li
- Dandan Wang
- Shuai Feng
- Quancai Chen
- Xiugui Sheng
- Jue Jia
- Xiaohui Yan
- Jian Zhu
- Yueju Yin
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Affiliations: Department of Gynecological Oncology, Shandong University Cancer Center, Jinan, Shandong 250117, P.R. China, Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Gynecology and Obstetrics, Wulian Maternal and Child Care Service Center, Rizhao, Shandong 262300, P.R. China, Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518116, P.R. China, Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Gynecological Oncology, Shandong University Cancer Center, Jinan, Shandong 250117, P.R. China
Published online on: May 31, 2022 https://doi.org/10.3892/ol.2022.13359
Article Number: 239
Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. The present study aimed to compare the therapeutic responses, toxicities and dosimetric parameters between intensity‑modulated radiation therapy (IMRT) and tomotherapy (TOMO) in patients with advanced cervical cancer. This retrospective study included 310 patients with stage IIB‑IIIB cervical cancer who underwent CCRT, with 155 patients in each group. Intracavitary brachytherapy was performed after a course of external beam radiation therapy (EBRT), or in the last week of pelvic EBRT. The treatment planning aim at point A (defined as a reference location 2 cm above the vaginal fornix and 2 cm beside the mid axis of the uterus) was >85 Gy in an equivalent dose at 2 Gy. There was no statistical difference with regard to clinicopathological characteristics between the two groups (P>0.05). Improved dose conformity and dose homogeneity (P<0.05) were observed in TOMO planning. TOMO provided more efficacious critical organ sparing than IMRT when assessing the percentage of normal tissue receiving at least 20 Gy (V20) for the bladder, the percentage of normal tissue receiving at least 40 Gy (V40) for the femoral head, and the V40 and V20 for the rectum (P<0.05). TOMO demonstrated a greater ability to protect the ovary (P<0.05). The acute radiation toxicity of proctitis and leukopenia were significantly lower in the TOMO group (P<0.05). The chronic radiation toxicity of radiation enterocolitis and cystitis was lower in the TOMO group (P<0.05). Thus, TOMO provided better critical organ sparing than IMRT. The radiation toxicities were acceptable. Therefore, TOMO appears to be a good option for the treatment of stage IIB‑IIIB cervical cancer.

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1	Bhatla N, Aoki D, Sharma DN and Sankaranarayanan R: Cancer of the cervix uteri. Int J Gynecol Obstet. 143 (Suppl 2):S22–S36. 2018. View Article : Google Scholar
2	Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A and Bray F: Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 71:209–249. 2021. View Article : Google Scholar : PubMed/NCBI
3	Dutta S, Nguyen NP, Vock J, Kerr C, Godinez J, Bose S, Jang S, Chi A, Almeida F, Woods W, et al: Image-guided radiotherapy and -brachytherapy for cervical cancer. Front Oncol. 5:642015. View Article : Google Scholar
4	Harkenrider MM, Alite F, Silva SR and Small W Jr: Image-based brachytherapy for the treatment of cervical cancer. Int J Radiat Oncol Biol Phys. 92:921–934. 2015. View Article : Google Scholar : PubMed/NCBI
5	Mackie TR, Holmes T, Swerdloff S, Reckwerdt P, Deasy JO, Yang J, Paliwal B and Kinsella T: Tomotherapy: A new concept for the delivery of dynamic conformal radiotherapy. Med Phys. 20:1709–1719. 1993. View Article : Google Scholar : PubMed/NCBI
6	Mackie TR, Kapatoes J, Ruchala K, Lu W, Wu C, Olivera G, Forrest L, Tome W, Welsh J, Jeraj R, et al: Image guidance for precision conformal radiotherapy. Int J Radiat Oncol Biol Phys. 56:89–105. 2003. View Article : Google Scholar : PubMed/NCBI
7	Balog J, Mackie TR, Pearson D, Hui S, Paliwal B and Jeraj R: Benchmarking beam alignment for a clinical helical tomotherapy device. Med Phys. 30:1118–1127. 2003. View Article : Google Scholar : PubMed/NCBI
8	Grigorov G, Kron T, Wong E, Chen J, Sollazzo J and Rodrigues G: Optimization of helical tomotherapy treatment plans for prostate cancer. Phys Med Biol. 48:1933–1943. 2003. View Article : Google Scholar
9	van Vulpen M, Field C, Raaijmakers CP, Parliament MB, Terhaard CH, MacKenzie MA, Scrimger R, Lagendijk JJ and Fallone BG: Comparing step-and-shoot IMRT with dynamic helical tomotherapy IMRT plans for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 62:1535–1539. 2005. View Article : Google Scholar : PubMed/NCBI
10	Chen YJ, Liu A, Han C, Tsai PT, Schultheiss TE, Pezner RD, Vora N, Lim D, Shibata S, Kernstine KH and Wong JY: Helical Tomotherapy for radiotherapy in esophageal cancer: A preferred plan with better conformal target coverage and more homogeneous dose distribution. Med Dosim. 32:166–171. 2007. View Article : Google Scholar : PubMed/NCBI
11	Lian J, Mackenzie M, Joseph K, Pervez N, Dundas G, Urtasun R and Pearcey R: Assessment of extended-field radiotherapy for stage IIIC endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy. Int J Radiat Oncol Biol Phys. 70:935–943. 2008. View Article : Google Scholar : PubMed/NCBI
12	Hsieh CH, Wei MC, Lee HY, Hsiao SM, Chen CA, Wang LY, Hsieh YP, Tsai TH, Chen YJ and Shueng PW: Whole pelvic helical tomotherapy for locally advanced cervical cancer: Technical implementation of IMRT with helical tomotherapy. Radiat Oncol. 4:622009. View Article : Google Scholar
13	Karnofsky DA and Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer. Evaluation of Chemotherapeutic Agents. Macleod CM: Columbia University Press; New York, NY: pp. p1961949
14	Pecorelli S: Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 105:103–104. 2009. View Article : Google Scholar
15	International Commission on Radiation Units and Measurements (ICRU), . Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU Report 50). ICRU Report. 62. ICRU; Bethesda, MD: 1999
16	Wang X, Zhang X, Dong L, Liu H, Gillin M, Ahamad A, Ang K and Mohan R: Effectiveness of noncoplanar IMRT planning using a parallelized multiresolution beam angle optimization method for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys. 63:594–601. 2005. View Article : Google Scholar : PubMed/NCBI
17	International Commission on Radiation Units and Measurements (ICRU), . Dose and volume specification for reporting intracavitary therapy in gynecology. ICRU Report. 38. ICRU; Bethesda, MD: ICRU1985.
18	Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, et al: New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 45:228–247. 2009. View Article : Google Scholar : PubMed/NCBI
19	Bruner DW: Outcomes research in cancer symptom management trials: The radiation therapy oncology group (RTOG) conceptual model. J Natl Cancer Inst Monogr. 37:12–15. 2007. View Article : Google Scholar
20	Peters WA III, Liu PY, Barrett RJ II, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr and Alberts DS: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 18:1606–1613. 2000. View Article : Google Scholar
21	Zhou GX, Xu SP, Dai XK, Ju ZJ, Gong HS, Xie CB, Yin LM and Yang J: Clinical dosimetric study of three radiotherapy techniques for postoperative breast cancer: Helical Tomotherapy, IMRT, and 3D-CRT. Technol Cancer Res Treat. 10:15–23. 2011. View Article : Google Scholar
22	Chitapanarux I, Nobnop W, Tippanya D, Sripan P, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B and Tharavichitkul E: Clinical outcomes and dosimetric study of hypofractionated Helical TomoTherapy in breast cancer patients. PLoS One. 14:e02115782019. View Article : Google Scholar : PubMed/NCBI
23	Guo MF, Liu XF, Liu L and Wang D; Department of Gynecologic Oncology, Chongqing University Cancer Hospital&Chongqing Cancer Institute&Chongqing Cancer Hospital, : (A dosimetric study of helical tomotherapy in radiotherapy after ovarian-conserving radical surgery for young patients with early-stage cervical cancer). J Chongqing Med Univ. 044:39–42. 2019.
24	Wiezorek T, Brachwitz T, Georg D, Blank E, Fotina I, Habl G, Kretschmer M, Lutters G, Salz H, Schubert K, et al: Rotational IMRT techniques compared to fixed gantry IMRT and tomotherapy: Multi-institutional planning study for head-and-neck cases. Radiat Oncol. 6:202011. View Article : Google Scholar
25	Clemente S, Wu B, Sanguineti G, Fusco V, Ricchetti F, Wong J and McNutt T: SmartArc-based volumetric modulated arc therapy for oropharyngeal cancer: A dosimetric comparison with both intensity-modulated radiation therapy and helical tomotherapy. Int J Radiat Oncol Biol Phys. 80:1248–1255. 2011. View Article : Google Scholar : PubMed/NCBI
26	Yang R, Xu S, Jiang W, Wang J and Xie C: Dosimetric comparison of postoperative whole pelvic radiotherapy for endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy. Acta Oncol. 49:230–236. 2010. View Article : Google Scholar
27	Engels B, De Ridder M, Tournel K, Sermeus A, De Coninck P, Verellen D and Storme GA: Preoperative helical tomotherapy and megavoltage computed tomography for rectal cancer: Impact on the irradiated volume of small bowel. Int J Radiat Oncol Biol Phys. 74:1476–1480. 2009. View Article : Google Scholar : PubMed/NCBI
28	Tournel K, De Ridder M, Engels B, Bijdekerke P, Fierens Y, Duchateau M, Linthout N, Reynders T, Verellen D and Storme G: Assessment of intrafractional movement and internal motion in radiotherapy of rectal cancer using megavoltage computed tomography. Int J Radiat Oncol Biol Phys. 71:934–939. 2008. View Article : Google Scholar : PubMed/NCBI
29	Gattaneo GM, Dell'oca I, Broggi S, Fiorino C, Perna L, Pasetti M, Sangalli G, di Muzio N, Fazio F and Calandrino R: Treatment planning comparison between conformal radiotherapy and helical tomotherapy in the case of locally advanced-stage NSCLC. Radiother Oncol. 88:310–318. 2008. View Article : Google Scholar
30	Yao B, Wang SH, Wang YD, Liu Q and Lu N: Acute and late toxicities and efficacy of helical tomotherapy and concurrent chemotherapy in the treatment of locally advanced cervical cancer. Oncol Prog. 14:544–547. 2016.
31	Rose BS, Aydogan B, Liang Y, Yeginer M, Hasselle MD, Dandekar V, Bafana R, Yashar CM, Mundt AJ, Roeske JC and Mell LK: Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy. Int J Radiat Oncol Biol Phys. 79:800–807. 2011. View Article : Google Scholar
32	Chang AJ, Richardson S, Grigsby PW and Schwarz JK: Split-field helical tomotherapy with or without chemotherapy for definitive treatment of cervical cancer. Int J Radiat Oncol Biol Phys. 82:263–269. 2012. View Article : Google Scholar : PubMed/NCBI
33	Lin MA: Clinical Application of Tomotherapy System. China Medical Devices. 29:12–14. 2014.(In Chinese). View Article : Google Scholar
34	Wang W, Zhang F, Hu K and Hou X: Image-guided, intensity-modulated radiation therapy in definitive radiotherapy for 1433 patients with cervical cancer. Gynecol Oncol. 151:444–448. 2018. View Article : Google Scholar