Why not de-intensification for uterine cervical cancer?

• Main Authors: Naoya Murakami, Ken Ando, Masumi Murata, Kazutoshi Murata, Tatsuya Ohno, Tomomi Aoshika, Shingo Kato, Noriyuki Okonogi, Anneyuko I. Saito, Joo Young Kim, Yasuko Kumai, Yasuo Yoshioka, Shuhei Sekii, Kayoko Tsujino, Chairat Lowanichkiattikul, Poompis Pattaranutaporn, Yuko Kaneyasu, Tomio Nakagawa, Miho Watanabe, Takashi Uno, Rei Umezawa, Keiichi Jingu, Ayae Kanemoto, Masaru Wakatsuki, Katsuyuki Shirai, Hiroshi Igaki, Jun Itami
• Other Authors: Hyogo Cancer Center
• Format: Article
• Published: 2022
• Subjects: Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/77829
• Institution: Mahidol University

Objective: The majority of uterine cervical cancer is known to be related to human papillomavirus (HPV), and HPV-related tumors are known to be radio-sensitive. In the management of HPV-related oropharyngeal cancer, de-intensification of treatment has been attempted; however, no such attempt is performed in the management of cervical cancer. The aim of this study was to identify a group of patients who can safely be treated by de-escalated treatment intensity. Methods: From the Asian international multi-institutional retrospective study involving 13 Japanese, one Thailand, and one Korean institutions based on 469 patients, squamous cell carcinoma (Scc), tumor reduction ratio ≥29%, tumor size before brachytherapy ≤4 cm, and total treatment time (TTT) <9 weeks were identified as factors having an influence on local control. Based on these findings, low-risk patients having these four factors were extracted, and treatment outcomes categorized in 10 Gy increment of CTVHR D90 were compared. Results: Among 469 patients, 162 patients (34.5%) met the criteria of low-risk group, and 63, 41, 43, and 15 patients were categorized in CTVHR D90 50–60 Gy, 60–70 Gy, 70–80 Gy, and >80 Gy, respectively. While 4-y progression-free survival ranged from 66 to 80%, 4-y local control was consistently over 90% in every dose group. Rectum and bladder D2cc and incidence of late adverse events decreased as CTVHR D90 decreased. Conclusions: The low-risk patients achieved favorable local control with CTVHR D90 <80 Gy. A personalized treatment strategy based on tumor response could also be adopted for cervical cancer.