2775 - Five-Year Audit of Node-Positive Cervical Cancer Treated with Simultaneous Integrated Boost: Clinical Outcomes and Toxicity Profile in the Era of FIGO 2018
Presenter(s)
K. Kamboj1, A. Ramadas2, D. N. Sharma3, S. Bhasker1, A. Sharma4, S. Mallick4, A. Amariyil5, A. Amritt1, S. K. K. Saini1, A. Vivekanandan4, N. Bhatla6, S. Sharma1, S. Hazarika4, J. Raj4, R. Pramanik7, B. Kataria8, and N. Das9; 1All India Institute of Medical Sciences, New Delhi, India, 2National Cancer Institute, AIIMS New Delhi, Delhi, India, 3AIl India Institute of Medical Sciences, New Delhi, India, 4National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India, 5AIIMS New Delhi, New Delhi, Delhi, India, 6All India Institute of Medical Sciences, NEW DELHI, India, 7DM Medical Oncology, AIIMS New Delhi, Delhi, India, 8All India Institute of Medical Sciences, Delhi, India, 9All India Institue of Medical Sciences, New Delhi, Delhi, Delhi, India
Purpose/Objective(s): To evaluate the clinical outcomes, including local control, as well as the acute and long-term toxicity profile of node-positive cervical cancer patients treated with Simultaneous Integrated Boost (SIB) over a five-year period following the adoption of the FIGO 2018 staging system.
Materials/Methods: This is a retrospective audit conducted at National Cancer Institute, India, analyzing patients with node-positive cervical cancer treated with SIB-VMAT and concurrent chemotherapy from November 2018 to November 2023, following the adoption of the FIGO 2018 staging system. Sixty-four patients were diagnosed with IIIC1 and IIIC2 cervical cancer during the study period and treated with concurrent chemoradiotherapy followed by brachytherapy. The radiotherapy dose was 45Gy in 25 fractions over 5 weeks to primary and elective nodes with SIB of upto 55-60 Gy to gross nodes. Brachytherapy was followed to achieve a total EQD2 of 85-90Gy. Response assessment was done using MRI / PETCT at 3 months, followed by 6monthly MRI and PETCT if indicated.
Results: The median age of the patient population was 48 years (range: 36–72 years). Based on the FIGO 2018 staging, 70.3% of patients had stage IIIC1, while 30% had stage IIIC2 disease. Among IIIC2 patients, 47% received neoadjuvant chemotherapy (NACT) before definitive chemoradiotherapy. The median follow-up was 24 months (12–48 months). At 24 months of follow-up, the local control rate was 92.1%, while the regional control rate was 100%. Residual disease or recurrence was observed in four patients with IIIC1 disease and one patient with IIIC2 disease. Distant metastases were noted in 11 patients (17%), with 6 cases in IIIC1 and 5 in IIIC2. The lungs were the most common site of metastases (8 patients), followed by the liver (4 patients). Notably, among patients who received neoadjuvant chemotherapy (NACT), no cases of distant metastasis or local recurrence were observed. The most common acute toxicity was gastrointestinal (GI) toxicity, with grade 3 upper GI and lower GI toxicity occurring in 6% and 9% of patients, respectively. Hematological toxicity was the second most common acute adverse event, with neutropenia = grade 3 occurring in 9% (6 patients) and one patient developing grade 3 thrombocytopenia. Among patients who received NACT, 22% developed = grade 3 hematological toxicity. The most common late toxicity was grade 3 proctitis, observed in 6% of patients. The median overall treatment time was 58 days.
Conclusion: The audit demonstrates that SIB-VMAT is an effective treatment approach for node-positive cervical cancer, achieving high local control rates. While distant metastases occurred in 17% of patients, none were observed in those who received NACT, suggesting a potential role of NACT in reducing systemic disease spread. These findings support the safety and efficacy of SIB-VMAT in this setting and highlight the need for further prospective studies to optimize patient selection, toxicity mitigation, and long-term outcomes.