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Radiotherapy

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Management of Gynecological Cancers in Older Women

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Abstract

Radiotherapy is well known that plays an essential role in the management of gynecological malignancies. It is delivered either for palliation or radical approach and often combined with other forms of treatment, such as surgery or chemotherapy. Though elderly patients tolerate irradiation treatment well, their particular physiological aspects should be always considered for the appropriate therapeutic decision making. The entry of technical advances in conjunction with the variability on treatment schedules makes the elder patients not to decline the irradiation when indicated while providing lower toxicity, rapidity of treatment delivery, and no impairment of therapeutic effectiveness. The encouragement of accrual enrolment of elder patients in prospective studies aiming to identify the best tailored irradiation treatment focusing on toxicity, efficacy, basing on their physiological and psychological aspects is mandatory.

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Abbreviations

EBRT:

External beam radiotherapy

PORTEC:

Postoperative radiation therapy for endometrial carcinoma trials

HIR:

High-intermediate risk

EC:

Endometrial cancer

LRR:

Local recurrence rate

HRQL:

Health-related quality of life

NAT:

No adjuvant treatment

PORTEC:

Postoperative radiation therapy for endometrial carcinoma trials

VBT:

Vaginal brachytherapy

GOG:

Gynecologic Oncology Group trials

DFS:

Disease-free survival

OS:

Overall survival

DSS:

Disease-specific survival

RR:

Rate range

CSS:

Cancer-specific survival

RT:

Radiotherapy

RTOG:

Radiation Therapy Oncology Group

IMRT:

Intensity-modulated radiotherapy

SEER:

Surveillance Epidemiology and End Results

NCI:

National Cancer Institute

5-FU:

5-fluorouracil

FIGO:

International Federation of Gynecology and Obstetrics

BT:

Brachytherapy

LDR:

Low-dose rate

SSR:

Specific survival rates

HDRICB:

High-dose-rate intracavitary brachytherapy

CCRT:

Concurrent chemoradiation therapy

HDR:

High-dose rate

GI:

Gastrointestinal

GU:

Genitourinary

References

  1. Cardenes HR, Look K, Michael H, Cerezo L. Endometrium. In: Perez CA, Brady LW, Halperin EC, editors. Principles and practice of radiation oncology. 5th ed. New York: Lippincott Williams & Wilkins; 2008. p. 1610–28.

    Google Scholar 

  2. Powell MEB. The role of radiation in endometrial cancer. J Gynecol Oncol. 2008;13:70–2.

    Google Scholar 

  3. Kong A, Simera I, Collingwood M. Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta-analysis. Ann Oncol. 2007;18(10):1595–604.

    Article  PubMed  CAS  Google Scholar 

  4. van Doorn HC, Opmeer BC, Jitze Duk M. The relation between age, time since menopause, and endometrial cancer in women with postmenopausal bleeding. Int J Gynecol Cancer. 2007;17(5):1118–23.

    Article  PubMed  Google Scholar 

  5. Keys HM, Roberts JA, Brunetto VL. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adeno- carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(3):744–51.

    Article  PubMed  Google Scholar 

  6. Creutzberg CL, Nout RA, Lybeert ML. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e631–8.

    Article  PubMed  Google Scholar 

  7. Nout RA, van de Poll-Franse LV, Lybeert ML. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the postoperative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011;29(13):1692–700.

    Article  PubMed  Google Scholar 

  8. Nout RA, Smit VT, Putter H. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375(9717):816–23.

    Article  PubMed  CAS  Google Scholar 

  9. Nout RA, Creutzberg CL. Point: vaginal brachytherapy should be a standard adjuvant treatment for intermediate-risk endometrial cancer. Brachytherapy. 2011;10(1):1–3.

    Article  PubMed  Google Scholar 

  10. Creutzberg CL, van Putten WL, Wárlám-Rodenhuis CC. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the postoperative radiation therapy in endometrial carcinoma trial. J Clin Oncol. 2004;22(7):1234–41.

    Article  PubMed  Google Scholar 

  11. Maggi R, Lissoni A, Spina F. Adjuvant chemotherapy vs. radiotherapy in high risk endometrial cancer: results of a randomised trial. Br J Cancer. 2006;95(3):266–71.

    Article  PubMed  CAS  Google Scholar 

  12. Greven K, Winter K, Underhill K. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk EC. Gynecol Oncol. 2006;103(1):155–9.

    Article  PubMed  CAS  Google Scholar 

  13. Hogberg T, Rosenberg P, Kristensen G. A randomized phase-III study on adjuvant treatment with radiation (RT)  ±  chemotherapy (CT) in early stage high-risk EC (NSGO-EC-9501/EORTC 55991), ASCO annual meeting proceedings part I. J Clin Oncol. 2007;25(18S):abstract 5503.

    Google Scholar 

  14. Randomized phase III trial comparing concurrent chemoradiation and adjuvant chemotherapy with pelvic radiation alone in high risk and advanced stage endometrial carcinoma: PORTEC-3. An international intergroup trial. [homepage on the Internet: Wong on line] [cited 2011 Nov 27]. Available from: http://clinicaltrials.gov/show/NCT00411138.

  15. Gynecologic Oncology Group trial-0249: a phase III trial of pelvic radiation therapy versus vaginal cuff brachytherapy ­followed by paclitaxel/carboplatin chemotherapy in patients with high risk, early stage endometrial carcinoma [homepage on the Internet: ClinicalTrials.gov]. 2008 [cited 2011 Nov 27]. Available from: http://clinicaltrials.gov/ct2/show/NCT00807768.

  16. Alektiar KM, Venkatraman E, Abu-Rustum N. Is endometrial carcinoma intrinsically more aggressive in elderly patients? Cancer. 2003;98(11):2368–77.

    Article  PubMed  Google Scholar 

  17. Jolly S, Vargas CE, Kumar T. The impact of age on long-term outcome in patients with endometrial cancer treated with postoperative radiation. Gynecol Oncol. 2006;103(1):87–93.

    Article  PubMed  Google Scholar 

  18. Citron JR. Pathologic stage I-II endometrial carcinoma in the elderly: radiotherapy indications and outcome. Int J Radiat Oncol Biol Phys. 2004;59(5):1432–8.

    Article  PubMed  Google Scholar 

  19. Zachariah B, Balducci L, Venkattaramanabalaji GV. Radiotherapy for cancer patients aged 80 and older: a study effectiveness and side effects. Int J Radiat Oncol Biol Phys. 1997;39(5):1125–9.

    Article  PubMed  CAS  Google Scholar 

  20. Alrefae MA, et al. Endometrial carcinoma in elderly women: disease outcome and treatment morbidity. Proceedings of the 49th annual ASTRO meeting abstract:2347 [homepage on the Internet: ASTRO Virtual Posters] [cited 2011 Nov 27] Available from: http://astro2007.abstractsnet.com.

  21. Pignon T, Horiot JC, Bolla M. Age is not a limiting factor for radical radiotherapy in pelvic malignancies. Radiother Oncol. 1997;42(2):107–20.

    Article  PubMed  CAS  Google Scholar 

  22. Citron JR, Sutton H, Yamada SD. Pathologic stage I-II endometrial carcinoma in the elderly: radiotherapy indications and outcome. Int J Radiat Oncol Biol Phys. 2004;59(5):1432–8.

    Article  PubMed  Google Scholar 

  23. Truong PT, Kader HA, Lacy B. The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer. Am J Clin Oncol. 2005;28(2):157–64.

    Article  PubMed  Google Scholar 

  24. Knab BR, Roeske JC, Mehta N. Outcome of endometrial cancer patients treated with adjuvant intensity modulated pelvic radiation therapy. Int J Radiat Oncol Biol Phys. 2004;60(1):S303–4, Supplement.

    Article  Google Scholar 

  25. Beriwal S, Jain SK, Heron DE. Dosimetric and toxicity comparison between prone and supine position IMRT for endometrial cancer. Int J Radiat Oncol Biol Phys. 2007;67(2):485–9.

    Article  PubMed  Google Scholar 

  26. Jhingran A, Winter K, Portelance L. Efficacy and safety of IMRT after surgery in patients with endometrial cancer: Rtog 0418 phase 2 study. Presentation: 89. 53RD ASTRO annual meeting [homepage on the Internet: ASTRO]. 2011 [cited 2011 Nov 27]. Available from: http://astro2011.abstractsnet.com.

  27. Henley SJ, King JB, German RR. Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) – United States, 2004–2006. MMWR Surveill Summ. 2010;59(9):1–25.

    PubMed  Google Scholar 

  28. Hong JH, Tsai CS, Lai CH, et al. Risk stratification of patients with advanced squamous cell carcinoma of cervix treated by radiotherapy alone. Int J Radiat Oncol Biol Phys. 2005;63:492–9.

    Article  PubMed  Google Scholar 

  29. Wright JD, Gibb RK, Geevarghese S. Cervical carcinoma in the elderly: an analysis of patterns of care and outcome. Cancer. 2005;103(1):85–91.

    Article  PubMed  Google Scholar 

  30. Sharma C, Deutsch I, Horowitz D. Patterns of care and treatment outcomes for elderly women with cervical cancer. Cancer. 2011. doi:10.1002/cncr.26589.

  31. Ikushima H, Takegawa Y, Osaki K. Radiation therapy for cervical cancer in the elderly. Gynecol Oncol. 2007;107(2):339–43.

    Article  PubMed  Google Scholar 

  32. Eifel PJ, Burke TW, Delclos L. Early stage I adenocarcinoma of the uterine cervix: treatment results in patients with tumors less than or equal to 4 cm in diameter. Gynecol Oncol. 1991;41(3):199–205.

    Article  PubMed  CAS  Google Scholar 

  33. Grigsby PW, Perez CA. Radiotherapy alone for medically inoperable carcinoma of the cervix: stage IA and carcinoma in situ. Int J Radiat Oncol Biol Phys. 1991;21(2):375–8.

    Article  PubMed  CAS  Google Scholar 

  34. Lanciano RM, Won M, Hanks GE. A reappraisal of the International Federation of Gynecology and Obstetrics staging system for cervical cancer. A study of patterns of care. Cancer. 1992;69(2):482–7.

    Article  PubMed  CAS  Google Scholar 

  35. Lindegaard JC, Thranov IR, Engelholm SA. Radiotherapy in the management of cervical cancer in elderly patients. Radiother Oncol. 2000;56(1):9–15.

    Article  PubMed  CAS  Google Scholar 

  36. Magné N, Mancy NC, Chajon E. Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol. 2009;91(2):197–201.

    Article  PubMed  Google Scholar 

  37. Chen SW, Liang JA, Yang SN. High dose-rate brachytherapy for elderly patients with uterine cervical cancer, Shang-Wen Chen. Jpn J Clin Oncol. 2003;33(5):221–8.

    Article  PubMed  Google Scholar 

  38. Balloni H, Melo MD, Novaes PERS. High dose-rate intracavitary brachytherapy in elderly patients with cervical cancer. Int J Radiat Oncol Biol Phys. 2009;75(3):S374.

    Article  Google Scholar 

  39. Low JS, Gao F, Yu T. Radiation Oncology, National Cancer Centre, Singapore, Singapore. Do elderly patients with cervical cancer fare worse with radiotherapy compared to their younger counterparts? Int J Radiat Oncol Biol Phys. 2005;63(2):S347–8.

    Article  Google Scholar 

  40. Suzuki K, Nishio M, Nishiyama N. The results of radiotherapy alone for cervical squamous cell carcinoma of the patients aged 75 and older. Int J Radiat Oncol Biol Phys. 2010;78(3):S407.

    Article  Google Scholar 

  41. Kunos C, Tian C, Waggoner S. Retrospective analysis of concomitant Cisplatin during radiation in patients aged 55 years or older for treatment of advanced cervical cancer: a Gynecologic Oncology Group study. Int J Gynecol Cancer. 2009;19(7):1258–63.

    Article  PubMed  Google Scholar 

  42. Ikushima H, Osaki K, Furutani S. Chemoradiation therapy for cervical cancer: toxicity of concurrent weekly cisplatin. Radiat Med. 2006;24(2):115–21.

    Article  PubMed  CAS  Google Scholar 

  43. Cetina L, Garcia-Arias A, Uribe Mde J. Concurrent chemoradiation with carboplatin for elderly, diabetic and hypertensive patients with locally advanced cervical cancer. Eur J Gynaecol Oncol. 2008;29(6):608–12.

    PubMed  CAS  Google Scholar 

  44. Punushapai U, Yuenyao P, Chumworathayi B. Weekly cisplatin 20 mg/m2 in patients with carcinoma of cervix receiving pelvic radiotherapy at Srinagarind Hospital: a randomized controlled trial. Asian Pac J Cancer Prev. 2010;11(1):201–7.

    PubMed  Google Scholar 

  45. Laurentius T, Altendorf-Hofmann A, Camara O. Impact of age on morbidity and outcome of concurrent radiochemotherapy in high-risk FIGO stage I to IVA carcinoma of the uterine cervix following laparoscopic surgery. J Cancer Res Clin Oncol. 2011;137(3):481–8.

    Article  PubMed  Google Scholar 

  46. Yoshida K, Sasaki R, Nishimura H. Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity. Arch Gynecol Obstet. 2011;284(4):1007–14.

    Article  PubMed  Google Scholar 

  47. Tanderup K, Nielsen SK, Nyvang GB. From point A to the sculpted pear: MR image guidance significantly improves tumour dose and sparing of organs at risk in brachytherapy of cervical cancer. Radiother Oncol. 2010;94(2):173–80.

    Article  PubMed  Google Scholar 

  48. Shih KK, Abu-Rustum NR, Barakat RR. Postoperative IMRT for cervical and endometrial cancer. Int J Radiat Oncol Biol Phys. 2011;81(2):S472.

    Article  Google Scholar 

  49. Holmsley HD, Bundy BN, Sedlis A. Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynaecologic Oncology Group study). Am J Obstet Gynecol. 1991;164(4):997–1004.

    Google Scholar 

  50. Petereit DG, Mehta MP, Buchler DA. Inguinofemoral radiation of N0, N1 cancer may be equivalent to lymphadenectomy if proper radiation technique is used. Int J Radiat Oncol Biol Phys. 1993;27(4):963–7.

    Article  PubMed  CAS  Google Scholar 

  51. Slevin NJ, Pointon RC. Radical radiotherapy for carcinoma of the vulva. Br J Radiol. 1989;62(734):145–7.

    Article  PubMed  CAS  Google Scholar 

  52. Perez CA, Grigsby PW, Galakatos A. Radiation therapy in management of carcinoma of the vulva with emphasis on conservation therapy. Cancer. 1993;71(11):3707–16.

    Article  PubMed  CAS  Google Scholar 

  53. Kumar PP, Good RR, Scott JC. Techniques for management of vulvar cancer by irradiation alone. Radiat Med. 1988;6(4):185–91.

    PubMed  CAS  Google Scholar 

  54. Ulutin HC, Pak Y, Dede M. Can radiotherapy be a treatment option for elderly women with invasive vulvar carcinoma without radical surgery? Eur J Gynaecol Oncol. 2002;23(5):426–8.

    PubMed  CAS  Google Scholar 

  55. Heaps JM, Yao SF, Montz FJ. Surgical-pathological variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol. 1990;38:309–14.

    Article  PubMed  CAS  Google Scholar 

  56. Hacker NF, Van der Velden J. Conservative management of early vulvar cancer. Cancer. 1993;71:1673–7.

    Article  PubMed  CAS  Google Scholar 

  57. Thomas GM, Dembo AJ, Bryson SC. Changing concepts in the management of vulvar cancer. Gynecol Oncol. 1991;42(1):9–21.

    Article  PubMed  CAS  Google Scholar 

  58. Faul CM, Mirmow D, Huang Q. Adjuvant radiation for vulvar carcinoma: improved local control. Int J Radiat Oncol Biol Phys. 1997;38(2):381–9.

    Article  PubMed  CAS  Google Scholar 

  59. Homesley HD, Bundy BN, Sedlis A. Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a gynecologic Oncology Group study). Gynecol Oncol. 1993;49(3):279–83.

    Article  PubMed  CAS  Google Scholar 

  60. Parthasarathy A, Cheung MK, Osann K. The benefit of adjuvant radiation therapy in single-node-positive squamous cell vulvar carcinoma. Gynecol Oncol. 2006;103(3):1095–9.

    Article  PubMed  Google Scholar 

  61. Fons G, Groenen SM, Oonk MH. Adjuvant radiotherapy in patients with vulvar cancer and one intra capsular lymph node metastasis is not beneficial. Gynecol Oncol. 2009;114(2):343–5.

    Article  PubMed  CAS  Google Scholar 

  62. Homesley HD, Bundy BN, Sedlis A. Radiation therapy versus pelvic node resection for ­carcinoma of the vulva with positive groin nodes. Obstet Gynecol. 1986;68(6):733–40.

    PubMed  CAS  Google Scholar 

  63. Van der Velden J, Fons G, Lawrie TA. Primary groin irradiation versus primary groin surgery for early vulvar cancer. Cochrane Database Syst Rev. 2011;(5):CD002224.

    Google Scholar 

  64. Van Zee AG, Oonk MH, Hullu JA. Sentinel node dissection is safe in the treatment of ­early-stage vulvar cancer. J Clin Oncol. 2008;26(6):884–9.

    Article  PubMed  Google Scholar 

  65. Boronow RC, Hickman BT, Reagan MT. Combined therapy as an alternative to exenteration for locally advanced vulvovaginal cancer. II. Results, complications, and dosimetric and surgical considerations. Am J Clin Oncol. 1987;10(2):171–81.

    Article  PubMed  CAS  Google Scholar 

  66. Anderson JM, Cassady JR, Shimm DS. Vulvar carcinoma. Int J Radiat Oncol Biol Phys. 1995;32(5):1351–7.

    Article  PubMed  CAS  Google Scholar 

  67. Russell AH, Mesic JB, Scudder SA. Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva. Gynecol Oncol. 1992;47(1):14–20.

    Article  PubMed  CAS  Google Scholar 

  68. Berek JS, Heaps JM, Fu YS. Concurrent cisplatin and 5-fluorouracil chemotherapy and radiation therapy for advanced-stage squamous carcinoma of the vulva. Gynecol Oncol. 1991;42(3):197–201.

    Article  PubMed  CAS  Google Scholar 

  69. Koh WJ, Wallace 3rd HJ, Greer BE. Combined radiotherapy and chemotherapy in the management of local-regionally advanced vulvar cancer. Int J Radiat Oncol Biol Phys. 1993;26(5):809–16.

    Article  PubMed  CAS  Google Scholar 

  70. Thomas G, Dembo A, DePetrillo A. Concurrent radiation and chemotherapy in vulvar carcinoma. Gynecol Oncol. 1989;34(3):263–7.

    Article  PubMed  CAS  Google Scholar 

  71. Tans L, Ansink AC, van Rooij PH. The role of chemo-radiotherapy in the management of locally advanced carcinoma of the vulva: single institutional experience and review of literature. Am J Clin Oncol. 2010;34(1):22–6.

    Article  Google Scholar 

  72. Stuckey A, Dizon D. Elderly patients four times more likely to die from treatment complications [Women & Infants Press release]. 2011[28 Nov 2011]. Available in: http://www.womenandinfants.org/body.cfm?id=89&action=detail&ref=454.

  73. Kucera H, Vavra N. Radiation management of primary carcinoma of the vagina: clinical and histopathological variables associated with survival. Gynecol Oncol. 1991;40(1):12–6.

    Article  PubMed  CAS  Google Scholar 

  74. Lilic V, Lilic G, Filipovic S. Primary carcinoma of the vagina. J BUON. 2010;15(2):241–7.

    PubMed  CAS  Google Scholar 

  75. Dixit S, Singhal S, Baboo HA. Squamous cell carcinoma of the vagina: a review of 70 cases. Gynecol Oncol. 1993;48(1):80–7.

    Article  PubMed  CAS  Google Scholar 

  76. Frank SJ, Jhingran A, Levenback C. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 2005;62(1):138–47.

    Article  PubMed  Google Scholar 

  77. Hegemann S, Schäfer U, Lellé R. Long-term results of radiotherapy in primary carcinoma of the vagina. Strahlenther Onkol. 2009;185(3):184–9.

    Article  PubMed  Google Scholar 

  78. Mock U, Kucera H, Fellner C. High-dose-rate (HDR) brachytherapy with or without external beam radiotherapy in the treatment of primary vaginal carcinoma: long-term results and side effects. Int J Radiat Oncol Biol Phys. 2003;56(4):950–7.

    Article  PubMed  Google Scholar 

  79. Stock RG, Chen AS, Seski J. A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol. 1995;56(1):45–52.

    Article  PubMed  CAS  Google Scholar 

  80. Andersen ES. Primary carcinoma of the vagina: a study of 29 cases. Gynecol Oncol. 1989;33(3):317–20.

    Article  PubMed  CAS  Google Scholar 

  81. Perez CA, Camel HM, Galakatos AE. Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int J Radiat Oncol Biol Phys. 1988;15(6):1283–90.

    Article  PubMed  CAS  Google Scholar 

  82. Di Donato V, Bellati F, Fischetti M. Vaginal cancer. Crit Rev Oncol Hematol. 2012;81:286–95.

    Article  PubMed  Google Scholar 

  83. Lian J, Dundas G, Carlone M. Twenty-year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol. 2008;111(2):298–306.

    Article  PubMed  Google Scholar 

  84. Lee WR, Marcus Jr RB, Sombeck MD. Radiotherapy alone for carcinoma of the vagina: the importance of overall treatment time. Int J Radiat Oncol Biol Phys. 1994;29(5):983–8.

    Article  PubMed  CAS  Google Scholar 

  85. McGonigle KF, Lavey RS, Juillard G. Complications of pelvic radiation therapy for gynecologic malignancies in elderly women. Int J Gynecol Cancer. 1996;6(2):149–55.

    Article  Google Scholar 

  86. Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294:2587–93.

    Article  PubMed  CAS  Google Scholar 

  87. Grigsby PW, Roberts HL, Perez CA. Femoral neck fracture following groin irradiation. Int J Radiat Oncol Biol Phys. 1995;32(1):63–7.

    Article  PubMed  CAS  Google Scholar 

  88. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340:1144–53.

    Article  PubMed  CAS  Google Scholar 

  89. Rose BS, Aydogan B, Liang Y. Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2011;79(3):800–7.

    Article  PubMed  CAS  Google Scholar 

  90. Mell LK, Tiryaki H, Ahn K-H. Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71(5):1504–10.

    Article  PubMed  Google Scholar 

  91. Loiselle C, Koh W-J. The emerging use of IMRT for treatment of cervical cancer. J Natl Compr Canc Netw. 2010;8:1425–34.

    PubMed  Google Scholar 

  92. Menkarios C, Azria D, Laliberté B. Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: a comparison of conventional and IMRT plans. Radiat Oncol. 2007;2:41–51.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Metaxa Cancer Hospital, Piraeus, Greece

    Athina Markouizou

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  1. Athina Markouizou
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  1. Memorial Sloan-Kettering Cancer Center, Commack Road, Commack, 11725, New York, USA

    Stuart M. Lichtman

  2. University of Liverpool, St Helens Teach, Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A. Audisio

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Markouizou, A. (2013). Radiotherapy. In: Lichtman, S., Audisio, R. (eds) Management of Gynecological Cancers in Older Women. Springer, London. https://doi.org/10.1007/978-1-4471-4605-6_8

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