A Cohort Study of Toxicities of Intensity Modulated Radiotherapy in Postoperative Patients of Carcinoma Cervix and Endometrium

Autor: Mohammad Ali, Kamal Sahni, Shantanu Sapru, Madhup Rastogi, Rohini Khurana, Rahat Hadi, Ajeet Kumar Gandhi, Sambit Swarup Nanda
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Journal of Clinical and Diagnostic Research, Vol 15, Iss 12, Pp 10-15 (2021)
Druh dokumentu: article
ISSN: 2249-782X
0973-709X
DOI: 10.7860/JCDR/2021/51345.15754
Popis: Introduction: Conventional Whole Pelvic Radiotherapy (WPRT) is associated with significant morbidity, especially haematological and Gastrointestinal (GI), which increases further with concurrent chemotherapy. Various studies have shown a clinical benefit of pelvic Intensity Modulated Radiotherapy (IMRT) but included a significant number of patients with intact cervix and uterus. Aim: The primary aim of the study was to record the toxicities of IMRT and the secondary aim was to detect its tolerance. Materials and Methods: This was a phase 2, single arm cohort study, conducted from August 2015 to October 2018 at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, including a total of 30 patients (23 cervical and seven endometrial cancer) who had undergone a total hysterectomy and required adjuvant pelvic irradiation. These patients were treated with pelvic IMRT using a dose of 45-50.4 Gray (Gy) at 1.8-2 Gy per fraction given as five fractions per week with/without concurrent chemotherapy (using injection cisplatin 35-40 mg/m2 per week) as per indications. Acute toxicities were recorded at weekly intervals during the treatment followed by the assessment of late toxicities at the time of each follow-up visits using Radiation Therapy Oncology Group (RTOG) radiation morbidity criteria. All outcomes were measured from the time of the start of radiotherapy to the time of acute event. Acute and late toxicities were assessed according to RTOG radiation morbidity criteria. Survival analysis was done using the Kaplan-Meier method. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) (IBM Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Results: Out of 30 patients, the highest grades of acute toxicities for skin, Lower Gastrointestinal (LGI), Genitourinary (GU), and haematological toxicities were grade 1, 2, 2 and 2, occurring in 11 (36.7%), 9 (30%), 4 (13.4%), and 1 (3.4%) of the cases, respectively. No late skin and GU toxicities were observed. Maximum late LGI toxicity was grade 1, occurring in 6.67% of the cases. Five (out of 30) patients developed treatment failures (two distant and three local). At a median follow-up of 35 months, the three year Progression Free Survival (PFS) and Overall Survival (OS) were 83.3% (all stages included). Conclusion: Considering acute and late adverse events in the form of skin, LGI, GU, and haematological toxicities, IMRT is well tolerated and has an acceptable toxicity profile even in the setting of an aggressive trimodality approach.
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