Rahmi Atıl Aksoy

Simultaneous integrated boost in locally advanced cervical cancer patients ineligible for brachytherapy: Dosimetric comparison of VMAT versus helical tomotherapy

Abstract Objective This retrospective, exploratory study evaluated the dosimetric comparison and feasibility of simultaneous integrated boost (SIB) delivered with volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) in patients with locally advanced cervical cancer ineligible for brachytherapy (BRT). Methods This exploratory study involved dosimetric treatment planning based on data from 10 patients diagnosed with locally advanced cervical cancer. SIB plans delivering 77.5 Gy to the primary tumor and 45 Gy to elective regions in 25 fractions were generated using VMAT and HT techniques. SIB plans were created using the VMAT technique in the Monaco 5.51 treatment planning system (TPS) (Elekta, Stockholm, Sweden) and the HT technique in the Precision 3.3.1 TPS (Accuray, Madison, Wisconsin, USA). Planning target volume (PTV) coverage, organ‐at‐risk (OAR) doses, and dose–volume metrics of SIB plans were compared between the VMAT and HT techniques using appropriate statistical tests. Results The median PTV77.5 volume was 83.4 cc (range: 14.9–218.2 cc). For PTV77.5, HT yielded a higher mean dose (79.52 Gy vs. 77.54 Gy,  p  = 0.001) and a superior conformity index (0.81 vs. 0.71,  p  < 0.001). Bladder dose metrics were significantly lower with HT, including V53.28 Gy (5.66% vs. 10.31%; p  = 0.006) and D 2cc (66.47 Gy vs. 70.60 Gy;  p  < 0.05), while bowel V36.89 Gy volume was also reduced (94.03 cc vs. 115.13 cc;  p  = 0.038). No statistically significant differences were observed in rectal, sigmoid, or femoral head dose parameters. Beam‐on time was significantly longer for HT than for VMAT (11.0 min vs. 3.4 min,  p  = 0.005). Conclusions BRT remains the standard of care for cervical cancer. For patients ineligible for BRT, SIB is dosimetrically feasible; in this exploratory planning study, HT‐SIB provided better target coverage and OAR sparing than VMAT‐SIB. Prospective multicenter validation is necessary before wider clinical adoption.

Comprehensive Evaluation of Inflammatory Biomarkers in Cervical Cancer Treated with Chemoradiotherapy

Objective: Inflammatory biomarkers have been shown to possess both prognostic and predictive significance in various cancers. Among the emerging biomarkers, the pan-immune-inflammation value (PIV) has recently been introduced as a novel indicator representing both the immune response and the systemic inflammatory state. This study aims to comprehensively evaluate the predictive value of inflammatory biomarkers on survival outcomes in cervical cancer patients undergoing chemoradiotherapy. Methods: A total of 90 patients who had undergone chemoradiotherapy for cervical cancer were included. Data on demographics, treatment protocols, pre-treatment blood parameters, and survival outcomes were collected. The association between inflammatory biomarkers and survival outcomes was investigated through univariate and multivariate analyses. Results: The univariate analysis identified the following as predictors of progression-free survival (PFS): neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), systemic immune-inflammation index (SII), PIV, C-reactive protein (CRP), albumin, and tumor size. Multivariate analysis revealed that only the PIV significantly predicted PFS (HR 3.05, 95% CI 1.0 to 9.3, p = 0.04). In the univariate analysis, several variables were predictive of overall survival (OS), including NLR, PLR, MLR, SII, PIV, CRP, LDH, albumin, tumor size, and Eastern Cooperative Oncology Group Performance Status (ECOG PS). Multivariate analysis revealed CRP (HR 3.41, 95% CI 1.5 to 7.7, p = 0.003) and ECOG PS (HR 4.78, 95% CI 1.3 to 17.3, p = 0.01) predictive of OS, with PIV approaching statistical significance (HR 2.56, 95% CI 0.8 to 7.6, p = 0.09). Conclusions: This study provides the first comprehensive analysis of the association between cervical cancer and various inflammatory biomarkers. Many of these biomarkers have demonstrated predictive value for survival outcomes in patients with cervical cancer undergoing definitive chemoradiotherapy. Among the biomarkers evaluated, CRP and PIV were identified as the most predictive, warranting further exploration in future research.