Updated results of toxicity and clinical outcome in carcinoma cervix treated with IG-IMRT and IGBT
Vachaspati Kumar Mishra,
India
PO-1429
Abstract
Updated results of toxicity and clinical outcome in carcinoma cervix treated with IG-IMRT and IGBT
Authors: Vachaspati Kumar Mishra1, Madhup Rastogi1, Ajeet Kr Gandhi1, Rohini Khurana1, Rahat Hadi2, Shantanu Sapru1, Surendra Prasad Mishra1, Anoop Kumar Srivastava1, Avinav Bharati1, Neetu Singh3
1Dr Ram Manohar Lohia Institute of Medical Sciences , Department of Radiation Oncology , Lucknow , India; 2Dr Ram Manohar Lohia Institute of Medical Sciences , Department of Radiation Oncology , Lucknow , India; 3Dr Ram Manohar Lohia Institute of Medical Sciences , Department of Obstetrics and Gynecology , Lucknow , India
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Purpose or Objective
To evaluate the clinical outcome and toxicity profiles in patients with locally advanced carcinoma cervix (LACC) treated with image guided intensity-modulated radiation therapy (IG-IMRT) and image-guided brachytherapy (IGBT).
Material and Methods
Between December 2019-November 2021, 25 patients of squamous cell carcinoma cervix with stage IB2-IIIC1 (FIGO 2018) were recruited in to this single arm prospective interventional study (CTRI/2020/08/027434). Whole pelvis IG-IMRT was delivered to a dose of 45Gy in 25 fractions with daily KV-CBCT (IIIC1 patients received 55 Gray in 25 fractions as nodal boost) with concurrent weekly cisplatin (40 mg/m2). Patients received IGBT of 7 Gy × 4 fractions to the High-Risk Clinical Target Volume (HR-CTV). The first fraction was done under MRI guidance and subsequent fractions under CT guidance. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events, version 5.0. Late toxicity was graded according to RTOG criteria. The primary endpoint was acute toxicity and secondary endpoint was late toxicity and clinical outcome in terms of loco-regional control.
Results
Patient characteristics are summarized in table 1. Median RT dose was 45Gy (45-55Gy). All patients received concurrent chemotherapy with median number of 5 cycles (4-5). Median overall treatment time was 8 weeks (7-10.5weeks). The median cumulative doses in terms of equivalent dose of 2 Gy (EQD2) of IGBT plus WP-IMRT for D90 HR-CTV,D2cc bladder,D2cc rectum, and D2cc sigmoid colon were 87Gy (81-95.8Gy), 72.95Gy (65.3-83.2Gy), 63.1Gy (57.8-68.8Gy) and 65.6Gy (61.2-75.2Gy), respectively. None of the patient reported grade 3 or 4 acute toxicity. Grade 1 and 2 diarrhea, grade 1 cystitis was reported in 4(16%), 3(12%) patients and 2(8%) patients respectively. Grade 1 anemia, grade 2 anemia, grade 1 dermatitis and grade 2 dermatitis were observed in 3(12%), 2(8%), 3(12%) and 3(12%) patients respectively. At a median follow-up of 24.6 months (18-30 months), late Grade 1 bladder toxicity was observed in 1(4%) patient. No late lower GI and skin toxicity seen till last date of follow-up.Loco-regional control at 6 and 12 months was 96% and 92% respectively.
Patient characteristics
| Distribution (n=25)
|
Median Age (Range)
| 52 years (29-65 years)
|
Median KPS (Range)
| 90 (80-100)
|
FIGO 2018 Stage IIA:IIB:IIIB:IIIC1
| 3(12%):10(40%):5(20%):7(28%)
|
Table 1 showing patients characteristics.
Conclusion
The combination of IG-IMRT and IGBT yielded favorable dose distribution to tumor volumes with sparing of OARs resulting in excellent outcome in terms of acute and late toxicity profile and loco-regional control.