eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2023
vol. 15
 
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abstract:
Original paper

Combination of image-guided IMRT and IGBT in locally advanced carcinoma cervix: Prospective evaluation of toxicities and clinical outcomes from a tertiary cancer center in India

Vachaspati Kumar Mishra
1
,
Madhup Rastogi
1
,
Ajeet Kumar Gandhi
1
,
Rohini Khurana
1
,
Rahat Hadi
1
,
Shantanu Sapru
1
,
Surendra Prasad Mishra
1
,
Anoop Kumar Srivastava
1
,
Neetu Singh
2

  1. Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
  2. Department of Obstetrics and Gynecology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
J Contemp Brachytherapy 2023; 15, 5: 308–316
DOI: https://doi.org/10.5114/jcb.2023.132553
Online publish date: 2023/10/30
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Purpose:
We aimed to assess the toxicity profile and clinical outcome in patients with locally advanced cervical cancer (LACC) treated with a combination of image-guided intensity-modulated radiation therapy (IG-IMRT) and image-guided brachytherapy (IGBT).

Material and methods:
25 LACC patients were recruited in this single-arm prospective study. Whole pelvis IG-IMRT was delivered (45 Gy with simultaneously integrated nodal boost of 55 Gy in 25 fractions), with concurrent weekly cisplatin (40 mg/m2). Patients received IGBT of 7 Gy each in 4 fractions to high-risk clinical target volume (HR-CTV). First fraction was done under MRI, and subsequent fractions were performed under CT guidance. Primary endpoint was acute toxicity, and secondary endpoints were 2-year loco-regional control and late toxicity.

Results:
The median age was 52 years, and FIGO 2018 stage distribution was IIA2, IIB, IIIB, and IIIC1 in 12%, 40%, 20%, and 28% patients, respectively. All patients received concurrent chemotherapy with median number of 5 cycles (range, 4-5 cycles). Grade 1 and 2 diarrhea, and grade 1 cystitis was reported in 4 (16%), 3 (12%), and 2 (8%) patients, respectively. Grade 1 and 2 anemia, and grade 1 and 2 dermatitis were observed in 3 (12%) and 2 (8%), and 3 (12%) and 3 (12%) patients, respectively. No patient reported grade 3-4 acute toxicity. At median follow-up of 29.5 months (range, 25-37 months), late grade 1 bladder toxicity was observed in 1 (4%) patient. Loco-regional control at 1 and 2 years were 96% and 92%, respectively.

Conclusions:
The combination of IG-IMRT and IGBT yielded excellent outcomes in terms of acute toxicity and loco-regional control.

keywords:

LACC, IG-IMRT, daily kV-CBCT, MRI-IGBT

  
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