Early Clinical Outcome and Acute Toxicities in Carcinoma Cervix Treated with IG-IMRT and IGBT
Vachaspati Kumar Mishra,
India
PO-1356
Abstract
Early Clinical Outcome and Acute Toxicities in Carcinoma Cervix Treated with IG-IMRT and IGBT
Authors: Vachaspati Kumar Mishra1, Madhup Rastogi1, Ajeet Kumar Gandhi1, Rohini Khurana1, Rahat Hadi1, Shantanu Sapru1, Surendra Prasad Mishra1, Anoop Kumar Srivastava1, Avinav Bharati1, Neetu Singh2
1Dr Ram Manohar Lohia Institute of Medical Sciences , Department of Radiation Oncology , Lucknow, India; 2Dr Ram Manohar Lohia Institute of Medical Sciences , Department of Obstetrics and Gynaecology , Lucknow, India
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Purpose or Objective
To evaluate the early clinical outcome and acute 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-August 2021, 20 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. The primary and secondary endpoints were acute toxicity and loco-regional control at 6 months, respectively.
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 D90HR-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. At the median follow-up of 12.5 months (6.6-19.6months), none of the patient reported grade 3 or 4 acute toxicity. Grade 1 and 2 diarrhea, grade 1 cystitis was reported in 3 (15%), 2(10%) patients and 2(10%) patients respectively. Grade 1 anaemia , grade 2 anaemia, grade 1 dermatitis and grade 2 dermatitis were observed in 3(15%), 2(10%), 3(15%) and 2(10%) patients respectively. Loco-regional control at 6 months was 95%.
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Patient
characteristics
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Distribution (n=20)
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Median Age (Range)
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52 years
(29-65 years)
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Median KPS (Range)
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90
(80-100)
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Differentiation (Well: Moderate: Poor)
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1(5%):16(80%):3(15%)
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FIGO 2018 Stage
IIA:IIB:IIIB:IIIC1
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3(15%):8(40%):2(10%):7(35%)
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Abbreviations: KPS=Karnofsky performance status, FIGO= International
Federation of Gynecology and
Obstetrics;
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Table 1 showing patient characteristics.
Conclusion
The combination of IG-IMRT and IGBT yielded excellent dose distribution to tumor volumes and sparing of OARs resulting in descent outcome in terms of acute toxicity profile and loco-regional control.