Comparison of Clinical Outcome and Toxicity in the Management of Carcinoma Cervix Treated with Conventional Vs Intensity Modulated Radiotherapy with Concurrent Chemotherapy
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 4, Pages 3584-3595
AbstractBackground: Carcinoma cervix is now the seventh most frequently diagnosed malignancy worldwide. The incidence is increasing in developing countries. Most cases of carcinoma cervix present at advanced stages. Concurrent Chemo-radiation is the standard of treatment in the case of locally advanced carcinoma cervix. The current study aimed to assess and compare the acute toxicities of Conventional RT with concurrent chemotherapy & IMRT with concurrent chemotherapy.
Methods: The prospective randomized study was conducted at MNJ Institute of Oncology and Regional Cancer Centre Blood Bank. RCC, Hyderabad. Patients included were those with Positive biopsy for squamous cell carcinoma and stage IIA-IIIB Carcinoma cervix patients according to FIGO Guidelines. After patients signed the consent form, they were randomized into either Group A or Group B by computer-generated random numbers. Group A: Concurrent chemo-radiation using IMRT followed by Brachytherapy. Group B: Concurrent chemo-radiation using Conventional RT followed by Brachytherapy.
Results: Moderately Differentiated Squamous Cell Carcinoma was the most common type with n=37 patients (73.3%) in Group A and n=29 patients (48.3%) in Group B. All patients received concurrent weekly Cisplatin at a dose of 40 mg/m2 of body surface area. The majority of patients in both arms received 4-5 cycles as shown in figure 3 below. 1 patient in Group A and 2 in Group B received 3 cycles. All patients in both groups started ICRT within 1 week of completion of EBRT. Group A, n=34 patients (57.6%) out of n=59 and in Group B, n=43 patients (75.4%) out of n=57 developed proctitis. No patient in either group had Grade 3 or 4 toxicity. The p-value for proctitis, when compared in both groups, was 0.0403, statistically significant.
Conclusion: toxicity between the two modalities of treatment was comparable with the advantage of IMRT in reducing the acute lower gastrointestinal toxicity. The loco-regional control was comparative in both groups. However, the limitation of this study was the short duration of follow-up. As a result, the late toxicity could be assessed only for a short period. So, there is a need for long-term follow-up.
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