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Acute toxicity profile of three-dimensional conformal concurrent chemoradiation in carcinoma cervix: an institutional experience

Published online by Cambridge University Press:  09 January 2020

Rajanigandha Tudu*
Affiliation:
Department of Radiotherapy, Rajendra Institute of Medical Sciences, Ranchi, India
Anup Kumar
Affiliation:
Department of Radiotherapy, Rajendra Institute of Medical Sciences, Ranchi, India
Rashmi Singh
Affiliation:
Department of Radiotherapy, Rajendra Institute of Medical Sciences, Ranchi, India
Payal Raina
Affiliation:
Department of Radiotherapy, Rajendra Institute of Medical Sciences, Ranchi, India
*
Author for correspondence: Rajanigandha Tudu, Department of Radiotherapy, Rajendra Institute of Medical Sciences, RIMS Campus, Senior Resident Quarter-15, Bariatu, Ranchi, Jharkhand834009, India. E-mail: rajanitudu@gmail.com

Abstract

Background:

Concurrent chemoradiation is the definitive treatment for advanced cervical cancer. Pelvic radiation is known to damage the adjacent normal tissues thereby causing acute toxicities. The modern conformal radiation techniques like three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy are known to reduce the toxicities and improve clinical outcomes.

Aim:

To retrospectively evaluate the frequency and severity of acute toxicities encountered during concurrent chemoradiation of locally advanced cancer cervix treated with 3D-CRT.

Methods:

The medical case records of 174 cervical cancer patients treated between November 2015 and November 2018 were studied. One hundred and thirteen histologically proven locally advanced cancer cervix patients (Stage IIB–IIIB) treated with concurrent 3D conformal chemoradiation between were included in the study. Patients received 46 Gy in 23 fractions with concurrent weekly cisplatin (40 mg/m2) on days 1, 8, 15 and 22 of radiation. The study endpoints were treatment-related toxicities which were graded according to CTCAE version 5.0.

Results:

One hundred and thirteen patients were analysed for the study. Gastrointestinal toxicity was the predominant toxicity observed followed by haematological toxicity. 31·7% patients reported grade 1–2 diarrhoea and 39·7% reported grade 1–2 leucopenia. None of the patients reported grade 3 or higher toxicities. Treatment interruptions were noted due to these toxicities.

Conclusion:

Concurrent chemoradiation is the definitive treatment for locally advanced carcinoma cervix with acceptable toxicities. Proper management measures should be undertaken for these toxicities to avoid treatment interruptions and ensure better treatment compliance.

Type
Original Article
Copyright
© Cambridge University Press 2020

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References

Bray, F, Ferlay, J, Soerjomataram, I, Siegel, RL, Torre, LA, Jemal, A. Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J Clin 2018; 68: 394424. doi: 10.3322/caac.21492 Google ScholarPubMed
Kirwan, JM, Symonds, P, Green, JA, Tierney, J, Collingwood, M, Williams, CJ. A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiother Oncol 2003; 68: 217226. Review. PubMed PMID:13129628.CrossRefGoogle ScholarPubMed
Lin, Y, Chen, K, Lu, Z et al. Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis. Radiat Oncol 2018; 13 (1), 177. doi: 10.1186/s13014-018-1126-7 CrossRefGoogle ScholarPubMed
Gerstner, N, Wachter, S, Knocke, TH, Fellner, C, Wambersie, A, Pötter, R. The benefit of Beam’s eye view based 3D treatment planning for cervical cancer. Radiother Oncol 1999; 51: 7178. PubMed PMID: 10386719.CrossRefGoogle ScholarPubMed
Keys, HM, Bundy, BN, Stehman, FB et al. Radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999; 340 (15): 11541161. doi: 10.1056/NEJM199904153401503. PMID: 10202166.CrossRefGoogle ScholarPubMed
Rose, PG, Bundy, BN, Watkins, EB et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer N Engl J Med 1999; 340 (15): 11441153. doi: 10.1056/NEJM199904153401502. PMID: 10202165.CrossRefGoogle ScholarPubMed
Whitney, CW, Sause, W, Bundy, BN et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjuvant to radiation therapy in stages IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes. A Gynecologic Oncology Group and Southwest Oncology Group Study. J Clin Oncol 1999; 17 (5): 13391348. doi: 10.1200/JCO.1999.17.5.1339. PMID:10334517.CrossRefGoogle Scholar
Morris, M, Eifel, PJ, Lu, J et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999; 340 (15): 11371143. doi: 10.1056/NEJM199904153401501. PMID: 10202164.CrossRefGoogle ScholarPubMed
Peters, WA, Liu, PY, Barrett, RJ et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early stage cancer of the cervix. J Clin Oncol 2000; 18 (8): 16061613. doi: 10.1200/JCO.2000.18.8.1606. PMID: 10764420.CrossRefGoogle ScholarPubMed
Green, JA, Kirwan, JM, Tierney, JF et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 2001; 358 (9284): 781786. doi: 10.1016/S0140-6736(01)05965-7. PMID: 11564482.CrossRefGoogle ScholarPubMed
Lukka, H, Hirte, H, Fyles, A et al. Concurrent cisplatin-based chemotherapy plus radiotherapy for cervical cancer—a meta-analysis. Clin Oncol 2002; 14 (3): 203212. doi: 10.1053/clon.2002.0076 CrossRefGoogle ScholarPubMed
Bhatla, N, Berek, JS, Cuello Fredes, M, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet 2019; 145: 129135. doi: 10.1002/ijgo.12749 CrossRefGoogle ScholarPubMed
Oken, MM, Creech, RH, Tormey, DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649655.CrossRefGoogle ScholarPubMed
Lim, K, Small, W Jr, Portelance, L, et al. Gyn IMRT Consortium. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Radiat Oncol Biol Phys 2011; 79: 348–55. doi: 10.1016/j.ijrobp.2009.10.075. Epub 14 May 2010.CrossRefGoogle ScholarPubMed
Gay, HA, Barthold, HJ, O’Meara, E et al. Pelvic normal tissue contouring guidelines for radiation therapy: a Radiation Therapy Oncology Group consensus panel atlas [published correction appears in Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):7]. Int J Radiat Oncol Biol Phys 2012; 83 (3): e353e362. doi: 10.1016/j.ijrobp.2012.01.023 CrossRefGoogle Scholar
U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Common Terminology Criteria for Adverse Events (CTCAE) v5.0, 27 November 2017.Google Scholar
Dracham, CB, Mahajan, R, Rai, B, Elangovan, A, Bhattacharya, T, Ghoshal, S. Toxicity and clinical outcomes with definitive three-dimensional conformal radiotherapy (3DCRT) and concurrent cisplatin chemotherapy in locally advanced cervical carcinoma, Jpn J Clin Oncol 2019; 49 (2): 146152. doi: 10.1093/jjco/hyy164 CrossRefGoogle ScholarPubMed
Laurentius, T, Altendorf-Hofmann, A, Camara, O, Runnebaum, IB, Wendt, TG. Impact of age on morbidity and outcome of concurrent radiochemotherapy in high-risk FIGO stage I to IVA carcinoma of the uterine cervix following laparoscopic surgery. J Cancer Res Clin Oncol 2011; 137: 481488.CrossRefGoogle Scholar