Clinical outcomes and toxicity of postoperative intensity-modulated versus three-dimensional conformal radiation therapy in patients with cervical cancer

Aim: To compare the clinical outcomes and toxicity of pelvic intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3D-CRT) as adjuvant postoperative treatment in patients with cervical cancer. Methods: Between April 2008 and December 2013, 115 patients with International Federation of Gynecology and Obstetrics stages IA-IIB cervical cancer were initially treated with radical hysterectomy and underwent adjuvant pelvic external-beam radiation therapy (EBRT) without brachytherapy. The median postoperative pelvic EBRT dose was 50 Gy (range, 45-50 Gy). Twenty-six patients received IMRT and 89 patients underwent 3D-CRT. Chemotherapy consisted of two to four courses of platinum-based treatment. Locoregional control, disease-free survival (DFS), overall survival (OS) and treatment-related complications were compared between the two groups. No significant difference in clinical data was observed between groups. Results: With a median follow-up of 28.6 months, 2-year OS rates were 90.3% in the 3D-CRT group and 91.6% in the IMRT group (P = 0.674), and DFS rates were 88.8% and 86.0%, respectively (P = 0.722). The rates of acute gastrointestinal (GI) and genitourinary (GU) toxicity were lower in the IMRT group than in the 3D-CRT group (GI, 50% vs 84.3%, P = 0.009; GU, 19.2% vs 56.2%, P = 0.007). Conclusion: Our results indicate that IMRT not only significantly reduced the rate of toxicity, but also provided good clinical outcomes consistent with those achieved with 3D-CRT. However, further studies with more patients and longer follow-up times are warranted to confirm the benefits of IMRT.