Is it time to modify the Japanese Uterine Cervical Cancer Guidelines to recommend a higher dose for radio-resistant tumors?. (14th November 2022)

• Record Type: Journal Article
• Authors: Murakami, Naoya; Okuma, Kae; Takahashi, Ayaka; Kato, Tomoyasu; Igaki, Hiroshi
• Is Part Of: Japanese journal of clinical oncology. Volume 53:Number 2(2023)
• Page Start: 179
• Page End: 181
• Publication Date: 2022-11-14
• Subjects: uterine cervical cancer -- Japanese uterine cervical cancer management guidelines -- dose-escalation -- chemoradiotherapy -- radiotherapy -- brachytherapy; Oncology -- Periodicals; Cancer -- Periodicals; 616.994005
• DOI: 10.1093/jjco/hyac171
• Languages: English
• ISSNs: 0368-2811

Abstract

Abstract: Compared with the European or the United States' uterine cervical cancer management guidelines, which aim to deliver >85 Gy EQD2 (the equivalent effective dose in 2 Gy per fraction) to the high-risk clinical target volume (CTVHR ) D90 (minimal dose of 90% of the CTVHR ), the dose goal of the corresponding Japanese guidelines does not recommend delivering such a high dose to the CTVHR D90 . Subsequently, while the rate of late radiation-induced toxicities is reported to be much lower in the Japanese schedule, the local control rate is relatively inferior to that of clinical results reported by the IntErnational study on MRI-guided BRAchytherapy in CErvical cancer study (EMBRACE-I) in which the dose goal for CTVHR D90 was >85 Gy and showed >90% local control regardless of tumor stage. In daily clinical practice, patients with residual disease supposedly due to insufficient total dose delivery are occasionally referred to our hospital for the possibility of re-irradiation, which is not usually recommended because the risk of late severe radiation-induced toxicity is high. In this report, the authors hope to raise a discussion in our community about modifying our treatment guidelines to recommend a higher dose at least for patients with poor response. Abstract : The European and American uterine cervical cancer guidelines recommend delivering > 85 Gy to the CTVHR D90, the Japanese guidelines do not recommend delivering such a high dose. Subsequently, while late toxicities in the Japanese schedule are milder than those in the Western schedule, local control is also lower. In this article, we hope to raise a discussion in our community about modifying our guidelines to recommend a higher dose, at least for patients with poor response.