Whole-uterine versus individualized-uterine radiotherapy in locally advanced cervical cancer: clinical outcome and toxicity

Abstract

Objective: Emerging evidence has suggested the safety and efficacy of individualized-uterine radiotherapy in locally advanced cervical cancer. This study aimed to compare the clinical outcomes and gastrointestinal toxicity of whole-uterine and individualized-uterine radiotherapy in women with locally advanced cervical cancer.

Methods: A retrospective analysis was conducted on 220 patients with stage IB3 to IVA cervical cancer, treated with definitive chemoradiotherapy between 2014 and 2021 at 2 tertiary centers. The clinical target volume included the entire uterus (whole-uterine group) or an individualized-uterine volume based on the gross tumor with a 15 mm margin (individualized-uterine group). Local recurrence rate, overall survival, and progression-free survival were evaluated using the Kaplan-Meier method. The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events was used to assess acute gastrointestinal toxicity, and a score of ≥3 indicated severe toxicity.

Results: Overall, 128 (58.2%) and 92 (41.8%) patients received whole- and individualized-uterine radiotherapy with a median follow-up of 63.0 (interquartile range; 39.4-93.2) months and 64.8 (interquartile range; 47.3-85.6) months, respectively. Compared to the whole-uterine group, the individualized-uterine group had significantly lower volumes of small bowel, rectum, and sigmoid colon exposed to 45 Gy or 30 Gy (all p < .05). The 5-year local recurrence rate, overall survival, and progression-free survival in the whole- and individualized-uterine groups were 4.1% vs 0.0% (p = .054), 84.9% vs 87.6% (p = .48), and 74.7% vs 84.8% (p = .07), respectively. Fewer patients in the individualized group reported severe acute gastrointestinal toxicity (5.4% vs 23.4%, p < .001). The 5-year rates of severe late gastrointestinal toxicity were 7.4% and 0.0% in the whole- and individualized-uterine groups, respectively (p = .009).

Conclusions: Individualized-uterine radiotherapy resulted in favorable clinical outcomes and reduced acute or late gastrointestinal toxicity compared to whole-uterine radiotherapy. This approach may offer an optimized balance between outcomes and toxicity in patients with locally advanced cervical cancer.

Keywords: Cervical Cancer; Chemoradiotherapy; Gastrointestinal Toxicity; Radiotherapy.