Clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy to the tumor center in the first course radiotherapy for bulky cervical cancer with massive bleeding

Objective To evaluate the clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) to the tumor center in the treatment of bulky cervical cancer with massive bleeding in the first course radiotherapy. Methods Twenty-one cases with bulky cervical cancer complicated with massive vaginal bleeding were enrolled. At the first three times of external irradiation, a high dose radiotherapy (15 Gy/3 fractions) was delivered to the tumor center (the region retracted 2 cm from the periphery of cervical mass), followed by conventional irradiation (2 Gy/fraction) in the posterior course. Conventional dose irradiation (46 Gy/23 fractions) was given to the tumor periphery and pelvic lymphatic drainage area throughout the whole course. Concurrent chemotherapy by cisplatin at a dose of 25 mg/m2 was delivered weekly. After the external irradiation, intracavitary radiotherapy was given (20 Gy/4 fractions). Results Within 24 h after the first course radiotherapy, the volume of vaginal bleeding was significantly decreased by 50% and the bleeding was almost stopped within one week. The hemostasis rate was 100%. Conclusions SIB-IMRT into the center of bulky cervical cancer is an efficacious treatment of massive vaginal bleeding. Key words: Cervical neoplasm/simultaneous integrated boost intensity-modulated radiotherapy; Massive bleeding; Hemostasis