PRACTICE PATTERNS OF RADIOTHERAPY IN CERVIX CANCER AMONG MEMBER

GROUPS OF THE GYNECOLOGIC CANCER

INTERGROUP (GCIG) D GAFFNEY1, A DU BOIS2, K NARAYAN3, N REED4, T TOITA5, S PIGNATA6, P

BLAKE7, L PORTELANCE8, A SADOYZE9, R POTTER10, A COLOMBO11, M RANDALL12, MR MIRZA13, EL TRIMBLE14,

1RTOG, USA  2AGO-OVAR, Germany  3ANZGOG, Australia/New Zealand  4EORTC, Scotland  5JGOG, Japan  6MITO, Italy  7Royal Marsden Hospital, England  8NCIC, Canada  9SGCTG, Scotland  10AGO-AUST, Austria 11MANGO, Italy 12GOG, USA

13NSGO, Scandinavia 14NCI, USA

RTOG USA JGOG Japan

MITO Italy

EORTC

ANZGOG Australia/New Zealand

AGO-OVAR GermanyMRC (NRCI)

NCIC Canada AGO-AUST Austria

SGCTG Scotland

MANGO Italy

NSGO Scandinavia

GEICO Spain

GINECO France

GOG USA

Methods

• Survey Developed• Radiotherapy practice

– Indications– Doses– Fields– Chemotherapy– Brachytherapy

• 4 questionnaires per group• 39 returned from 13 groups• Descriptive statistics

RT Doses

0

10

20

30

40

50

60

70

80

post Hyst definitivepelvic

Total Dosepoint A

Total Dosepoint B

post Hystpara-aortic

Definitivepara-aortic

Gy 47.9 +/- 2.9

48.0 +/- 3.5

79.1 +/- 7.9

57.9 +/- 5.5

45.6 +/- 2.7

46.9 +/- 5.1

Total Point A Doses: North America Compared to Other Cooperative

Groups

0

10

20

30

40

50

60

70

80

90

North America other Groups

SD=6.0SD=8.6

Gy81.8

77.4

p=0.103

Type of Simulation for Definitive RT

CTFluoroMRI fusion

33

1 1

Size of Pelvic Field for Definitive RT

Large L4/5Small L5/S1NOSCT planned

174

5

8

N=34

IMRT in Definitive RT?

noyesLN boostson study

21

2

22

N=27

Type of Chemotherapy for Definitive RT?

CDDPCDDP/5FUCDDP/Taxol5FU/Nedaplatin30

24

1

N=37

Dosing of CDDP for Definitive RT (n=30)

40 mg/m2 weekly30 mg/m2 weekly

8 mg/m2 qd 20 mg/m2 d1-5 q 3wk

Adjuvant Chemo post Hysterectomy and Concurrent ChemoRT

Yes No Varies

23

9

2

N=34

Intervene for a low Hemoglobin

Yes No Maybe

1 1

31

N=33

Type of Brachytherapy for Definitive RT

Tandem and Ovoid

Tandem and Ring

Either

1 3

25

N=29

Indications for Para-aortic RT

+ Para-aortics+ Common Iliacs+ LN's NOS+ Ext IliacsNot performed

20

18

14

Upper Border for Para-aortic RT

T10/11

T11/12T12/L1

CT Planned15

74

5

N=31

Vaginal Brachytherapy post Hysterectomy

• 18 Rx’d to ½ cm, 8 to Vag surface, 1 to one cm

• 23/25 recorded dose to bladder and rectum

• 23/27 used HDR• For HDR

– Median dose: 17.5 Gy– Median dpf: 6 Gy

2 cm

4 cm

5 cm

1/3

1/2

2/3

whole

ovoids

varies

Degree of Vagina Treated

Conclusions

• Radiotherapy Practices among members of GCIG are similar in terms of doses and fields

• Concomitant chemotherapy is used by all groups with CDDP predominating

• There is no consensus on vaginal brachytherapy prescription

• Radiotherapy practices should not be a barrier to intergroup participation in clinical trials

Acknowledgments

• Mason Schoenfeldt and Monica Bacon

• Executive Board of the GCIG

• Respondents

• Collegiality among all members