Image-Guided Radiotherapy and Chemotherapy in Gynaecological Cancer

Studies comparing different dose levels

Author (ref) acrual period

Vaginal recurrence

Locoregional recurrence

No. patients, eligibility

Treatment

Survival

Severe complications

Studies with different brachytherapy dose levels

Kloetzer et al. 30 108; Stage I-II

4 x 10 Gy at 0.5 cm 0,0% 2,2% 98% OS at 3-years 2.2% / 0.0% grade 3/4 3,1% 3,1% 97% OS at 3-years 6.2% / 3.1% grade 3/4 4 x 10 Gy at 1 cm + vagina 0,0% 0,0% 97% OS at 3-years 6.8% / 12.6% grade 3/4 4 x 10 Gy at 1 cm

1981-1990

Osrund et al. 37 217; Stage I-II

4 x 5.5 Gy at 0.5 cm 1,0% 4 x 5.5 Gy individualized 2,5%

26% / 8% grade 1/2 17% / 1% grade 1/2

1988-1996

at 0.3-0.4-0.5 cm

no grade 3/4

Sorbe et al. 34

290; Stage IA grd 1-2 6 x 2.5 Gy at 0.5 cm vs.

0,7% 1,4% 95% OS at 5-years vaginal shortening

1989-2003

6 x 5.0 Gy at 0.5 cm

0.3 cm vs. 2.1 cm

• Higher dose + including whole length increased severe morbidity and shortening of the vagina • Osrund: individualized prescription 0.3 – 0.4 – 0.5 cm less grade 1-2 vaginal morbidity