TITLE:
Acute Toxicity of Three Dimensional Conformal Concurrent Chemoradiation with Dose Optimization for External Beam Radiation in Carcinoma Cervix—A Prospective Study
AUTHORS:
Sathish Balachandran, Shyama Prem Sudha, Reddy KS, Saravanan Kandasamy
KEYWORDS:
3D Conformal, Dose Optimization, Acute Radiation Toxicity
JOURNAL NAME:
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology,
Vol.5 No.3,
August
31,
2016
ABSTRACT: Aim: To prospectively evaluate the acute toxicity of 3D conformal
radiotherapy with dose optimization in patients with carcinoma cervix. Materials
and Methods: Carcinoma cervix patients stage IIB to IIIB (n = 30) treated
during November 2011 to May 2013 at the institution with 3D conformal
chemo-radiation were included in the study. They received weekly Cisplatin 40 mg/m2 for a maximum of 5 cycles. They received 46 Gy/23 fractions, 5 fractions per
week of external beam radiation. In these patients dose optimization was done
in order to achieve a tumor maximum dose (Dmax) around
105%. Various techniques were used for dose optimization which included the use
of sub fields, adjusting the weightages, using wedges and the use of mixed
energies. EBRT (External Beam Radiotherapy) was followed by two fractions of
high dose rate intracavitary brachytherapy of 9 Gy each. Acute RTOG toxicity
was assessed weekly during EBRT and 1 week post EBRT. Results: The median age
of the patients was 45 (range: 30 - 55 years). All the patients completed EBRT;
63.3% of the patients received all 5 cycles of chemotherapy while 26.6% of the
patients received 4 cycles of chemotherapy and 10% of the patients received 3
cycles of chemotherapy. The most predominant toxicity seen was GI toxicity,
diarrhea being the most common GI toxicity followed by vomiting. Neutropenia
was the most common hematological toxicity. Most patients had grade 0 and grade
1 toxicity. None of the patients had grade 4 toxicity while few had grade 2 and
3 toxicity. Conclusion: 3D conformal concurrent chemo radiotherapy with Dmaxaround
105% reduces acute RTOG toxicity particularly grade 3 and 4 and improves
patient compliance for concurrent chemo-radiotherapy.