OUTCOME AND TOXICITY OF EXTENDED-FIELD INTENSITY MODULATED RADIOTHERAPY (EF-IMRT) IN LOCALLY ADVANCED CARCINOMA OF CERVIX – EXPERIENCE FROM TERTIARY CANCER CENTER

Authors

  • ANJAN BERA Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India. https://orcid.org/0000-0003-1571-1449
  • AVIK MAJI Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India. https://orcid.org/0000-0002-3820-8232
  • DEBJANI BANERJEE Department of Physiology, Barasat Government Medical College and Hospital, Kolkata, West Bengal, India https://orcid.org/0000-0003-0705-4688
  • DEBOJYOTI MANNA Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India https://orcid.org/0000-0002-3838-6426
  • SHILPI ADHIKARY Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India

DOI:

https://doi.org/10.22159/ajpcr.2024v17i8.51519

Keywords:

Locally advanced,, Cervical cancer,, Extended field radiotherapy.

Abstract

Objectives: Whether to irradicate the para-aortic node prophylactically or not in locally advanced cervical carcinoma in the absence of para-aortic lymphadenopathy, the recommendation varies across guidelines. Extended field radiotherapy may improve overall survival (OS) by better local control of the para-aortic nodal region compared to pelvic RT alone, especially in patients unable to tolerate concurrent pelvic chemoradiotherapy.

Methods: This was a single institutional retrospective study carried out in the department of radiotherapy at NRSMCH, Kolkata. A total of 30 HPE-proven locally advanced cervical cancer patients treated with extended field intensity-modulated radiotherapy (IMRT) were selected for this retrospective study.

Results: Response assessment was done 12–16 weeks after completion of treatment and 26 patients (86%) had complete locoregional responses and four patients had the local disease (14%). The 2-year OS was 86%. The common toxicity was Grade I small bowel toxicity (diarrhea), skin reactions, and Grade I neutropenia, seen in 78%, 63%, and 58% of patients, respectively. Another acute toxicity was Grade I anemia seen in 35% of patients. The common late toxicity was Grade I lower GI (11%).

Conclusions: Extended Field-IMRT is a convenient, feasible, and effective treatment modality for target coverage and para-aortic nodal control with minimal toxicity.

Downloads

Download data is not yet available.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209-49. doi: 10.3322/caac.21660, PMID: 33538338

Chopra SJ, Mathew A, Maheshwari A, Bhatla N, Singh S, Rai B, et al. National cancer grid of India consensus guidelines on the management of cervical cancer. J Glob Oncol. 2018 Jul;4:1-15. doi: 10.1200/ JGO.17.00152, PMID: 30085891, PMCID: PMC6223405

Biswas L, Bera A, Manna D, Mondal S. Epidemiology of cervical cancer: A retrospective study in tertiary health-care center in Kolkata over one decade. Int J Med Sci Public Health. 2019 Nov;8:971-4. doi: 10.5455ijmsph.2019.0925914092019

Chopra S, Gupta M, Mathew A, Mahantshetty U, Engineer R, Lavanya G, et al. Locally advanced cervical cancer: A study of 5-year outcomes. Indian J Cancer. 2018 Jan-Mar;55(1):45-49. doi: 10.4103/ ijc.IJC_428_17, PMID: 30147092

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Cervical Cancer Version 1. Philadelphia, PA: National Comprehensive Cancer Network; 2023. Available from: https://www.nccn.org [Last accessed on 2023 May 16].

Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, Munsell MF, Coleman RL, et al. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: A prospective correlation of surgical findings with positron emission tomography/ computed tomography findings. Cancer. 2011 May 1;117(9):1928-34. doi: 10.1002/cncr.25739, PMID: 21509770, PMCID: PMC4286384

Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: An update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004 Mar 1;22(5):872-80. doi: 10.1200/JCO.2004.07.197, PMID: 14990643

Viswanathan AN. Uterine cervix. In: Halperin EC, Wazer ED, Perez CA, Brady LW, editors. 7th ed. Principles and Practice of Radiation Oncology. Philadelphia, PA: Lippincott Williams and Wilkins; 2019. p. 1800-915.

Loiselle C, Koh WJ. The emerging use of IMRT for treatment of cervical cancer. J Natl Compr Canc Netw. 2010 Dec;8(12):1425-34. doi: 10.6004/jnccn.2010.0106, PMID: 21147905

Simpson DR, Paravati AJ, Yashar CM, Mell LK, Mundt AJ. Cervical cancer. In: Lee NY, Riaz N, Lu JJ, editors. 1st ed. Target Volume Delineation for Conformal and Intensity-Modulated Radiation Therapy. Switzerland: Springer International Publishing; 2015. p. 329-28.

Vargo JA, Kim H, Choi S, Sukumvanich P, Olawaiye AB, Kelley JL, et al. Extended field intensity modulated radiation therapy with concomitant boost for lymph node-positive cervical cancer: Analysis of regional control and recurrence patterns in the positron emission tomography/computed tomography era. Int J Radiat Oncol Biol Phys. 2014 Dec 1;90(5):1091-8. doi: 10.1016/j.ijrobp.2014.08.013, PMID: 25303889

Liang JA, Chen SW, Hung YC, Yeh LS, Chang WC, Lin WC, et al. Low-dose, prophylactic, extended-field, intensity-modulated radiotherapy plus concurrent weekly cisplatin for patients with stage IB2-IIIB cervical cancer, positive pelvic lymph nodes, and negative para-aortic lymph nodes. Int J Gynecol Cancer. 2014 Jun;24(5):901-7. doi: 10.1097/IGC.0b013e31829f4dc5, PMID: 23975081

Ray A, Sarkar B. Small bowel toxicity in pelvic radiotherapy for postoperative gynecological cancer: Comparison between conformal radiotherapy and intensity-modulated radiotherapy. Asia Pac J Clin Oncol. 2013 Sep;9(3):280-4. doi: 10.1111/ajco.12049, PMID: 23279854

Chopra S, Dora T, Chinnachamy AN, Thomas B, Kannan S, Engineer R, et al. Predictors of grade 3 or higher late bowel toxicity in patients undergoing pelvic radiation for cervical cancer: Results from a prospective study. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):630-5. doi: 10.1016/j.ijrobp.2013.11.214, PMID: 24521678

Fernandez-Ots A, Crook J. The role of intensity modulated radiotherapy in gynecological radiotherapy: Present and future. Rep Pract Oncol Radiother. 2013 Oct 3;18(6):363-70. doi: 10.1016/j.rpor.2013.08.001, PMID: 24416580, PMCID: PMC3863203

Li XL, Chen ZY, Cui YC, Sheng XG. Simultaneous modulated accelerated radiotherapy in cervical cancer with retroperitoneal lymph node metastasis after radical hysterectomy and pelvic lymphadenectomy. Int J Gynecol Cancer. 2015 Jun;25(5):903-9. doi: 10.1097/IGC.0000000000000426, PMID: 25822099

Kunogi H, Yamaguchi N, Terao Y, Sasai K. Kidney-sparing methods for extended-field intensity-modulated radiotherapy (EF-IMRT) in cervical carcinoma treatment. PLoS One. 2016 Jun 3;11(6):e0156623. doi: 10.1371/ journal.pone.0156623, PMID: 27258030, PMCID: PMC4892687

Published

07-08-2024

How to Cite

ANJAN BERA, AVIK MAJI, DEBJANI BANERJEE, DEBOJYOTI MANNA, and SHILPI ADHIKARY. “OUTCOME AND TOXICITY OF EXTENDED-FIELD INTENSITY MODULATED RADIOTHERAPY (EF-IMRT) IN LOCALLY ADVANCED CARCINOMA OF CERVIX – EXPERIENCE FROM TERTIARY CANCER CENTER”. Asian Journal of Pharmaceutical and Clinical Research, vol. 17, no. 8, Aug. 2024, pp. 52-55, doi:10.22159/ajpcr.2024v17i8.51519.

Issue

Section

Original Article(s)