Long Term Clinical Outcome and Late Toxicity of Intensity Modulated Versus Conventional Pelvic Radiation Therapy for Locally Advanced Cervix Carcinoma
Journal Title: Journal of Clinical and Diagnostic Research - Year 2019, Vol 13, Issue 3
Abstract
ABSTRACT Introduction: Role of intensity modulated radiotherapy in definitive management of Locally Advanced Cervical Carcinoma (LACC) is not yet well defined with limited available literature. Aim: We had earlier reported early clinical outcome and acute toxicities in patients with locally advanced carcinoma cervix treated with Whole Pelvic Conventional Radiotherapy (WP-CRT) versus Intensity Modulated Radiotherapy (WP-IMRT). This study aims to evaluate the long term clinical outcome and late toxicities. Materials and Methods: A total of 44 patients of stage IIB-IIIB {International Federation of Gynaecology and Obstetrics (FIGO 2009)} squamous cell carcinoma of the cervix was randomised between WP-CRT or WP-IMRT to receive 50.4 Gy in 28 fractions with weekly cisplatin 40 mg/m2 followed by high dose rate intracavitary brachytherapy (7 Gy in 3 fractions each one week apart). Survival was calculated from the date of initiation of treatment. Late toxicity was graded as per the Radiation Therapy Oncology Group (RTOG) system. Results: A total of 22 patients each were assigned to the two treatment arms. Out of 44 patients, 13 and 12 patients belonged to stage IIB; 9 and 10 patients had stage IIIB disease respectively in WP-CRT and WP-IMRT arms. Median follow-up time was 46.7 months (22.8-59.8 months) for the WP-IMRT and 51.23 months (21.7-59.8 months) for the WP-CRT arm. Five-year loco-regional failure free survival and distant metastasis free survival rates were 85.7% versus 90.9% (p=0.58) and 76.4% versus 69.4% (p=0.79) in WP-IMRT versus WP-CRT respectively. Five-year disease free survival and overall survival rate in the WP-IMRT arm versus the WP-CRT were 72.7% versus 66.2% (p=0.80) and 72.4% versus 74.4% (p=0.61). For combined Grade-1-3, patients in the WP-IMRT arm experienced significantly fewer chronic gastrointestinal toxicity (18.2% versus 50%, p=0.027). Grade-2 late bladder toxicity was seen more in WP-CRT arm versus WP-IMRT arm (13.6% versus 0%, p=0.116). Conclusion: WP-IMRT continues to show comparable long term survival outcome and is associated with significantly less chronic gastrointestinal toxicity compared to WP-CRT. We suggest the use of WP-IMRT for LACC till further results from ongoing multicentric trial are available.
Authors and Affiliations
Ajeet Kumar Gandhi, Daya Nand Sharma, Goura Kishor Rath, Pramod Kumar Julka, Vellaiyan Subramani, Seema Sharma, Durai Manigandan, Sunesh Kumar
Keywords
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- EP ID EP580901
- DOI 10.7860/JCDR/2019/40260.12741
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