br Fuquan Zhang and Ke
1 Fuquan Zhang and Ke Hu contributed equally to this work.
Cervical cancer is one of the most common cancers in China. In 2015, it K 252a was estimated that there were 98.9 thousand new cases and 30.5 thousand deaths from cervical cancer . With the use of the human papillomavirus (HPV) vaccine, the incidence of cervical cancer decreased in developed countries in the past decades. However, the incidence did not decrease significantly in elderly women .
In most large retrospective studies, the treatment outcomes of elderly cervical cancer patients are worse than those of patients who are younger [3e5]. It worth noting that elderly patients were likely to have more advanced disease and receive less aggressive treatment [3e7]. The worse survival of elderly patients potentially
1028-4559/© 2019 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
was mainly the result of more advanced disease and less aggres-sive treatment rather than age itself. After definitive radiotherapy alone, elderly patients had an equivalent survival to young pa-tients [8,9]. At present, concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer. In a previous study, we found that elderly patients could benefit from concurrent chemotherapy . However, it is an inconclusive issue whether the survival of elderly patients is equivalent to that of young patients in the era of CCRT, and the literature on this issue is limited [11,12]. In the present study, we compared the treatment outcomes and toxicities of patients treated with definitive radiotherapy or CCRT between young and elderly patients.
Patients and methods
We reviewed the database of patients with cervical cancer treated with definitive radiotherapy in our institute from January
2010 to December 2015. The inclusion criteria were as follows: biopsy-confirmed cervical cancer, FIGO stage IB-IVA, and treated with definitive radiotherapy or CCRT. To compare the treatment outcomes between young and elderly patients, patients aged less than 60 years (young group) and those aged 70 years and older (elderly group) were selected. This study was approved by the Institutional Review Board of Peking Union Medical College Hospital.
Before treatment, patients completed a physical examination, a gynecological examination, routine laboratory tests, pelvic mag-netic resonance imaging (MRI) or computed tomography (CT), and chest and abdomen CT.
All patients were scheduled to receive definitive intensity modulated radiation therapy (IMRT) and intracavitary brachyther-apy (ICBT).
The gross tumor volume (GTV) and clinical target volume (CTV) were delineated on the CT slices. The GTV was defined as the regional metastatic lymph nodes (MLNs). And, the CTV covered the primary tumor, the GTV, the cervix, uterus, parametrium, upper part of the vaginal and regional lymph node regions, including the common iliac, internal iliac, external iliac, obturator, presacral, with/without para-aortic lymph node regions. Planning gross tu-mor volume (PGTV) was defined as the GTV plus a margin of 5 mm. The planning clinical target volume (PCTV) was generated with a margin of 6e10 mm added to the CTV. A dose of 50.4 Gy in 28 fractions was delivered to the PCTV with IMRT. And, the PGTV was simultaneously boosted to 59e61 Gy in 28 fractions. A dose of 30e36 Gy in 5e7 fractions was prescribed to point A with high dose rate ICBT.
The first-line regimen of concurrent chemotherapy was weekly cisplatin. For patients with renal dysfunction, weekly paclitaxel was given. The detailed treatment approach was described previously [10,13].