Page 43 - ARNM-1-1

Advances in Radiotherapy
& Nuclear Medicine CCRT plus nimotuzumab for cervical cancer

combined with high-dose-rate (HDR) brachytherapy and fixed in a supine position with the body membrane and
cisplatin-based concurrent chemotherapy was the main underwent an enhanced computed tomography (CT)
treatment method for locally advanced cervical cancer . scan with a 5-mm layer thickness. Next, the CT scan data
[3]
In the 1990s, five randomized controlled trials, including were transmitted to the ELEKTA treatment plan system
GOG 120, GOG 123, GOG 85, RTOG 90 – 01, and (Oncentra 4.3) to delineate target areas and organs at risk.
SWOG 8797, defined concurrent RT and chemotherapy The clinical target volume (CTV) included the uterus,
as standard treatments for advanced cervical cancer. cervix, tumor, vaginal tissue 3 cm below the tumor,
This strategy reduced the mortality risk by 30 – 50% [4-8] . parametrium, paravaginal tissues, and the pelvic lymph
Furthermore, GOG 120 identified 40 mg/m /week cisplatin node regions. In addition, for a subgroup of patients, CTV
2
as a synchronous chemotherapy regimen . Although included the para-aortic lymph node regions up to the renal
[5]
concurrent chemoradiotherapy (CRT) has proven vein level. The planning target volume (PTV) was CTV
beneficial, more than 35% of the patients experienced plus 0.5 – 0.8 cm. Gross tumor volume of metastatic lymph
relapse with recurrent or metastatic tumors. Local or nodes (GTVnd) refers to the metastatic lymph nodes that
pelvic failure remained the main cause of relapse in such are radiographically visible. The PTV of GTVnd (PGTVnd)
cases. Recurrence or metastasis in patients with cervical was GTVnd plus 0.3 – 0.5 cm.
cancer, especially in patients with recurrence within the
RT field, was difficult to treat and accompanied by multiple The volumetric modulated arc therapy plan was
complications and unsatisfactory quality of life. Therefore, designed to ensure or meet the following requirements:
it was necessary to explore a more effective treatment to (i) The >95% prescription dose must include 95% of the
improve the prognosis of patients with locally advanced PTV; (ii) <10% of the PTV should receive 110% of the
cervical cancer. prescription dose; and (iii), <1% of the PTV should receive
<93% of the prescribed dose. Dose limitations for normal
Nimotuzumab is a monoclonal antibody targeting tissue were as follows: V40 of the bladder and rectum
the epidermal growth factor receptor (EGFR), and its ≤50%, V40 of the small intestine and colon ≤25%, V30 of
combination with CRT is recommended for the treatment the small intestine and colon ≤50%, V50 of the femoral
of locally advanced nasopharyngeal carcinoma in China . head ≤5%, single kidney average dose <16 Gy, and the
[9]
EGFR overexpression was also observed in cervical cancer. maximum dose of the spinal cord <45 Gy. The energy of
In this study, we assessed the safety of nimotuzumab
combined with CRT in the treatment of locally advanced the X-ray used was 6 MV. We prescribed 50.4 Gy/1.8 Gy/28
cervical squamous cell carcinoma (LACSCC) and F for PTV and 60 Gy/2.14 Gy/28 F for PGTVnd. For the
parametrium of the patient in stage IIIB, the total dose
performed a preliminary evaluation of the clinical efficacy.
reached 60 Gy. Cone-beam CT was performed every time
2. Methods before treatment in the first five fractionations and every
week in the following fractionations.
2.1. Patient enrollment and inclusion criteria
Patients with locally advanced cervical cancer, who 2.2.2. Intracavitary brachytherapy
received nimotuzumab combined with CRT at our center Patients received 192 Ir HDR intracavitary brachytherapy
from December 2013 to March 2017, were enrolled in when they had been treated with 36 – 40 Gy of EBRT. The
this study. Inclusion criteria were as follows: (i) Age dose at point A was 30 – 36 Gy/5 – 6 times.
in the range of 18–75 years; (ii) LACSCC (Stages IB2,
IIA2–IVA) confirmed by pathology; (iii) no previous CRT; 2.2.3. Chemotherapy
(iv) good general physical condition (Karnofsky score ≥70); The patients received 40 mg/m cisplatin chemotherapy once
2
(v) expected survival time ≥6 months; and (vi) treated a week from the 1 day of EBRT. Adjuvant chemotherapy
st
with nimotuzumab combined with concurrent intensity- consisted of four cycles of paclitaxel (135–175 mg/m ) plus
2
modulated RT (IMRT) and chemotherapy. Patients cisplatin (70–75 mg/m ) chemotherapy, with a cycle of
2
who received no concurrent chemotherapy or HDR 21 days.
brachytherapy were excluded. The study was approved by
the ethics committee of our hospital. 2.2.4. Nimotuzumab
2.2. Treatment strategy Nimotuzumab was administered at a dose of 200 mg from
the 1 day of EBRT, once a week. At each treatment, 200 mg
st
2.2.1. EBRT of nimotuzumab was dissolved in 250 mL of 0.9% normal
Before positioning, patients were instructed to empty the saline and administered through an intravenous drip for
rectum and drink water to fill the bladder. Patients were more than 1 h.

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/arnm.0408