Radiotherapy dose escalation with concurrent chemotherapy in locally advanced cervix cancer is feasible
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To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity.
Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment.
Mean age was 46 (30–63) and 47 years (33–67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I–II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I–III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity.
VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT “Box”. We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT.
KeywordsVMAT Cervix cancer Radiotherapy dose escalation Treatment toxicity
Compliance with ethical standards
This study has been approved by the institutional ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to therapy; however, for retrospective review of data with less than minimal risk to the patients, no consent was required by the ethics committee. All authors declare that there is no conflict of interest.
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