2819 - Stereotactic Radiotherapy Boost in Locally Advanced Cervical Carcinoma Patients (STARBACS): Up-to-Date Results of a Phase II, Single Arm, Monoinstitutional Study
Presenter(s)
S. Parisi1, G. Ferrantelli2, A. M. Attisano2, C. Martinelli3, V. Sciacca2, E. Trifiletti2, M. Sciacca2, A. Potami4, A. Brogna5, C. Siracusa6, A. Ercoli7, G. Iati'1,8, and S. Pergolizzi1; 1Radiation Oncology Unit - Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy, 2University of Messina, BIOMORF Department, Messina, Italy, 3Sbarro Institute for Cancer Research and Molcelular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, US, Philadelphia, PA, 4Radiation Oncology Unit, University hospital "G. Martino", Messina, Messina, Italy, 5Medical Physics Unit - Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy, 6University hospital "G. Martino", Messina, Messina, Italy, 7University of Messina, Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva Gaetano Barresi, Messina, Italy, 8University of Messina, Radiation Oncology Unit, Messina, Italy
Purpose/Objective(s): To evaluate feasibility, toxicities, and clinical outcome (Local Control) in locally advanced cervical cancer (LACC) patients treated with concurrent radiation therapy and platinum-based chemotherapy followed by stereotactic body radiation therapy (SBRT) boost. The hypothesis is that it is possible to deliver a dose boost with SBRT in LACC patients who underwent chemo-radiotherapy (CT-RT).
Materials/Methods: From March 2021 to December 2024, we evaluated all patients with a diagnosis of locally advanced cervical cancer (LACC), assigned with curative intent to platinum-based chemo-radiotherapy (CT-RT), and unsuitable to brachytherapy (i.e. implant refusal, impassable vaginal stenosis, impassable cervical canal stenosis). These patients have been submitted to Stereotactic Boost using a Robotic Arm LINAC.
Results: 51 patients with LACC (M0) have been enrolled. At the time of primary diagnosis all patients had FIGO 2009-2018 stage from IIb to IIIC. Median age was 51 years (range 32-72); 42/51 had histological diagnosis of squamous-cell carcinoma HPV-related and 9/51 had histological diagnosis of adenocarcinoma. During concurrent treatments all patients received weekly Platinum-based chemotherapy (40mg/mq) plus radiotherapy to a total dose on clinical target volume (CTV) of 45-50.4 Gy (1.8 Gy/fraction). All patients have been submitted to SBRT-boost (Gold Fiducial tracking) with a median total dose delivered of 21 Gy/3 fraction (range 12-24Gy) on gross tumor volume (GTV) after restaging with contrast-enhanced MRI and 18-FDG-PET. An isotropic margin of 2mm (PTV) on GTV has been applied. To contour we matched simulation-CT with contrast-enhanced MRI using the software for deformable imaging fusion. G1-G2 toxicities were: 62% dysuria, 50% fatigue G2, 10% anemia, 20% leukopenia, 25% thrombocytopenia, 5% diarrhea, 10% nausea and vomiting. None of the patients showed toxicities = G3. Median FU time 10 months (range 1-45 months). We observed Complete/Partial response (CR and PR, respectively) in 82.4% of the cases, with 30/51 CR (58.9%) and 12/51 (23.5%) PR. Progressive disease was reported in 13 patients (7 local progression, 1 local and systemic, 5 systemic).
Conclusion: These preliminary results showed that SBRT boost was feasible and well tolerated with encouraging results in terms of local control. Our data seem to indicate that this kind of therapy is a valid therapeutic option in LACC patients who cannot be submitted to endocavitary brachytherapy. At the best of our knowledge this is the largest study reported in English literature using a Robotic Arm LINAC.