Vol 94, No 2 (2023)
Research paper
Published online: 2022-02-08

open access

Page views 3510
Article views/downloads 846
Get Citation

Connect on Social Media

Connect on Social Media

Clinical study of acute toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy for cervical cancer

Shuangshaung Sun1, Zhi Chen1, Pingping Li1, Jian Wu1, Baoling Zhu1, Xi Zhang1, Congcong Wu1, Ruifang Lin1, Yingying Zhou1, Wenjun Chen1
Pubmed: 35156692
Ginekol Pol 2023;94(2):101-106.

Abstract

Objectives: To compare the dose volume of the target area and the toxicity of pelvic bone marrow-sparing intensity-modulated radiotherapy (PBMS-IMRT) with routine IMRT in patients undergoing radiochemotherapy for cervical cancer.

Material and methods: Forty patients with indications for adjuvant radiochemotherapy after cervical cancer surgery were selected and randomly divided into IMRT (n = 20) and PBMS-IMRT (n = 20) groups to observe and record the toxicity and its severity in the blood, gastrointestinal tract, and genitourinary system.

Results: There was no significant difference in the target area conformity index (CI) or homogeneity index (HI) between the two groups (p > 0.05). The pelvic bone V10–V50 in the PBMS-IMRT group were lower than those in the IMRT group (p < 0.05), and there was lower hematological toxicity (p < 0.05) and fewer delays or interruptions in chemotherapy and/or radiotherapy (p < 0.05) in the PBMS-IMRT group. The toxicity to the gastrointestinal and genitourinary systems in the two groups was not significantly different (p > 0.05).

Conclusions: PBMS-IMRT significantly reduced the dose volume of the pelvic bone marrow, thereby reducing the incidence of bone marrow suppression. However, it had no significant impact on the gastrointestinal or genitourinary systems.

Article available in PDF format

View PDF Download PDF file

References

  1. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999; 340(15): 1144–1153.
  2. Datta NR, Stutz E, Liu M, et al. Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer: A systematic review and meta-analysis. Gynecol Oncol. 2017; 145(2): 374–385.
  3. Vordermark D. Radiotherapy of Cervical Cancer. Oncol Res Treat. 2016; 39(9): 516–520.
  4. Kirwan JM, Symonds P, Green JA, et al. A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiother Oncol. 2003; 68(3): 217–226.
  5. Nicholas S, Chen L, Choflet A, et al. Pelvic Radiation and Normal Tissue Toxicity. Semin Radiat Oncol. 2017; 27(4): 358–369.
  6. Mauch P, Constine L, Greenberger J, et al. Hematopoietic stem cell compartment: acute and late effects of radiation therapy and chemotherapy. Int J Radiat Oncol Biol Phys. 1995; 31(5): 1319–1339.
  7. Hui B, Zhang Y, Shi F, et al. Association between bone marrow dosimetric parameters and acute hematologic toxicity in cervical cancer patients undergoing concurrent chemoradiotherapy: comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy. Int J Gynecol Cancer. 2014; 24(9): 1648–1652.
  8. Bao Z, Wang D, Chen S, et al. Optimal dose limitation strategy for bone marrow sparing in intensity-modulated radiotherapy of cervical cancer. Radiat Oncol. 2019; 14(1): 118.
  9. Mell LK, Sirák I, Wei L, et al. INTERTECC Study Group. Bone marrow-sparing intensity modulated radiation therapy with concurrent cisplatin for stage IB-IVA cervical cancer: an international multicenter phase II clinical trial (INTERTECC-2). Int J Radiat Oncol Biol Phys. 2017; 97(3): 536–545.
  10. Albuquerque K, Giangreco D, Morrison C, et al. Radiation-related predictors of hematologic toxicity after concurrent chemoradiation for cervical cancer and implications for bone marrow-sparing pelvic IMRT. Int J Radiat Oncol Biol Phys. 2011; 79(4): 1043–1047.
  11. Lim K, Small W, Portelance L, et al. Gyn IMRT Consortium. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Radiat Oncol Biol Phys. 2011; 79(2): 348–355.
  12. Terret C, Albrand G, Moncenix G, et al. Karnofsky Performance Scale (KPS) or Physical Performance Test (PPT)? That is the question. Crit Rev Oncol Hematol. 2011; 77(2): 142–147.
  13. Green JA, Kirwan JM, Tierney JF, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001; 358(9284): 781–786.
  14. Chen SW, Liang JA, Hung YC, et al. Concurrent weekly cisplatin plus external beam radiotherapy and high-dose rate brachytherapy for advanced cervical cancer: a control cohort comparison with radiation alone on treatment outcome and complications. Int J Radiat Oncol Biol Phys. 2006; 66(5): 1370–1377.
  15. Phillips P, Phillips J. Hysterectomy with radiotherapy or chemotherapy or both for women with locally advanced Cervical Cancer. Clin Nurse Spec. 2017; 31(4): 189–190.
  16. Kong W, Wang Y, Lv N, et al. Incidence of radiation enteritis in cervical cancer patients treated with definitive radiotherapy versus adjuvant radiotherapy. Journal of Cancer Research and Therapeutics. 2018; 14(8): 120.
  17. Zhu He, Zakeri K, Vaida F, et al. Longitudinal study of acute haematologic toxicity in cervical cancer patients treated with chemoradiotherapy. J Med Imaging Radiat Oncol. 2015; 59(3): 386–93; quiz 394.
  18. Peng W, Zhao Y. Comparative of patients with cervical cancer using 3D-CRT and IMRT. 2016 9th International Congress on Image and Signal Processing, BioMedical Engineering and Informatics (CISP-BMEI). 2016.
  19. Lujan AE, Mundt AJ, Yamada SD, et al. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys. 2003; 57(2): 516–521.
  20. Mell LK, Sirák I, Wei L, et al. INTERTECC Study Group. Bone Marrow-sparing Intensity Modulated Radiation Therapy With Concurrent Cisplatin For Stage IB-IVA Cervical Cancer: An International Multicenter Phase II Clinical Trial (INTERTECC-2). Int J Radiat Oncol Biol Phys. 2017; 97(3): 536–545.
  21. Huang J, Gu F, Ji T, et al. Pelvic bone marrow sparing intensity modulated radiotherapy reduces the incidence of the hematologic toxicity of patients with cervical cancer receiving concurrent chemoradiotherapy: a single-center prospective randomized controlled trial. Radiat Oncol. 2020; 15(1): 180.
  22. Lujan AE, Mundt AJ, Yamada SD, et al. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys. 2003; 57(2): 516–521.
  23. Gandhi AK, Sharma DN, Rath GK, et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys. 2013; 87(3): 542–548.
  24. Mundt AJ, Roeske JC, Lujan AE, et al. Initial clinical experience with intensity-modulated whole-pelvis radiation therapy in women with gynecologic malignancies. Gynecol Oncol. 2001; 82(3): 456–463.