scholarly journals Long-Term Toxicity and Efficacy of Intensity-Modulated Radiation Therapy in Cervical Cancers: Experience of a Cancer Hospital in Pakistan

2020 ◽  
pp. 1639-1646
Author(s):  
Muhammad Atif Mansha ◽  
Tabinda Sadaf ◽  
Asmara Waheed ◽  
Amna Munawar ◽  
Asma Rashid ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Tumor Size ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Grade 3

PURPOSE To report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer. METHODS AND MATERIALS Between January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated. RESULTS A total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery ( P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates ( P < .05). CONCLUSION IMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.

scholarly journals Postoperative pelvic intensity-modulated radiation therapy reduced the incidence of late gastrointestinal complications for uterine cervical cancer patients

2019 ◽  
Vol 60 (5) ◽  
pp. 650-657 ◽  
Author(s):  
Keisuke Tsuchida ◽  
Naoya Murakami ◽  
Tomoyasu Kato ◽  
Kae Okuma ◽  
Hiroyuki Okamoto ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Radical Hysterectomy ◽  
Intensity Modulated Radiation Therapy ◽  
Pathological Finding ◽  
Gastrointestinal Complications ◽  
Intensity Modulated ◽  
Gastrointestinal Obstruction ◽  
Significant Difference

Abstract The aim of the study was to compare incidences of late gastrointestinal adverse events and clinical outcomes between 3D conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) after radical hysterectomy for cervical cancer patients. Between March 2007 and May 2014, 73 cervical cancer patients with high-risk prognostic factors (pelvic lymph node metastasis and/or parametrial invasion) underwent postoperative pelvic radiation therapy (RT) after radical hysterectomy. Of these patients, 33 (45%) and 40 (55%) received 3DCRT and IMRT, respectively. Because the gastrointestinal obstruction rate after postoperative pelvic 3DCRT was high, no concurrent chemotherapy was applied until 2015. The median follow-up period for patients with 3DCRT and IMRT was 82 months (6–113) and 50 months (5–74), respectively. There was no significant difference in overall survival (OS) (4-year OS: 85% vs 78%, P = 0.744) or disease-free survival (DFS) (4-year DFS: 73% vs 64%, P = 0.696) between the two groups. Eleven (33%) and 13 (33%) patients experienced recurrence after 3DCRT and IMRT, respectively. The patients who had vaginal invasion from the postoperative pathological finding more frequently had loco-regional recurrence than the patients who did not have vaginal invasion (2.3% vs 17%, P = 0.033). Gastrointestinal obstruction was observed in 9 (27%) and 3 (7.5%) patients for 3DCRT and for IMRT, respectively (P = 0.026). Severe gastrointestinal obstruction that required surgery was observed in 6 (19%) patients, all of whom received adjuvant RT by 3DCRT. IMRT could reduce the incidence of late severe gastrointestinal obstruction after postoperative pelvic RT with a non-inferior clinical efficacy compared with 3DCRT.

Postradiation Damage to the Pelvic Girdle in Cervical Cancer Patients: Is Intensity-Modulated Radiation Therapy Safer Than Conventional Radiation?

2014 ◽  
Vol 24 (4) ◽  
pp. 806-812 ◽  
Author(s):  
Yevgeniya Jane Mikhailovna Ioffe ◽  
Travis J. Hillen ◽  
Gongfu Zhou ◽  
Julie K. Schwarz ◽  
L. Stewart Massad ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Pelvic Girdle ◽  
Cervical Carcinomas ◽  
Intensity Modulated ◽  
Conventional Radiation ◽  
Treatment Type ◽  
Group 3

ObjectivesIntensity-modulated radiation therapy (IMRT) is frequently utilized in the treatment of cervical cancer. Our study compared instances of pelvic fractures, osteonecrosis, and osteomyelitis posttreatment with conventional radiation therapy (RT) versus IMRT in patients with cervical carcinomas.MethodsEighty-three patients primarily treated with IMRT were case matched with 83 historical control subjects treated with conventional RT. Pretreatment and posttreatment computed tomography scans were reviewed. Logistic regression analysis was utilized to examine the effects of treatment type (conventional RT vs IMRT) on the occurrence of posttreatment pelvic bony structure complications while adjusting for confounders.ResultsIn the IMRT group, 3 (4%) of 83 patients developed posttreatment sacral fractures (median follow-up, 51 months). In the conventional RT group, there were 14 pelvic girdle complications (17%): 9 fractures, 2 cases of osteonecrosis, and 3 cases of osteomyelitis (median follow-up, 43.5 months; odds ratio, 4.49 for conventional vs IMRT groups,P= 0.01; 95% confidence interval, 1.4–14.1). In addition, there were 4 cases of posttreatment osteoporosis in the conventional RT group. All patients with complications in the IMRT group and 11 of 13 in the conventional RT group were symptomatic.ConclusionsIntensity-modulated radiation therapy is associated with a lower risk for pelvic girdle complications than conventional RT.

Extended-Field Intensity-Modulated Radiotherapy and Concurrent Cisplatin-Based Chemotherapy for Postoperative Cervical Cancer With Common Iliac or Para-Aortic Lymph Node Metastases: A Retrospective Review in a Single Institution

2012 ◽  
Vol 22 (7) ◽  
pp. 1220-1225 ◽  
Author(s):  
Guangyu Zhang ◽  
Chunli Fu ◽  
Youzhong Zhang ◽  
Jianbo Wang ◽  
Naian Qiao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Field Intensity ◽  
Intensity Modulated Radiotherapy ◽  
Endocrine Function ◽  
Ovarian Transposition ◽  
Intensity Modulated ◽  
Extended Field ◽  
Grade 3

ObjectiveRetrospectively, to assess the toxicity of delivering postoperative extended-field intensity-modulated radiotherapy (EF-IMRT) and concurrent cisplatin chemotherapy for patients with cervical cancer with a pathologically confirmed positive common iliac node and/or a para-aortic node.MethodsEach patient received postoperative EF-IMRT and concurrent cisplatin chemotherapy. The clinical target volume included regional lymph node regions (obturator; common, internal, and external iliac nodal regions; presacral region; and para-aortic regions) and the upper 2.0 cm of the vagina and paravaginal soft tissue lateral to the vagina. The acute and late toxicity were scored using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively.ResultsFifty-eight patients were treated with postoperative EF-IMRT and concurrent cisplatin chemotherapy. The median follow-up was 34 months. Eighteen patients (31%) had recurrence. The region of recurrence was in-field in 2 patients (3.4%) and out-field in 16 patients (27.6%). Acute grade 3 or higher gastrointestinal, genitourinary, and hematologic toxicity occurred in 2, 1, and 11patients, respectively. Three patients (5.1%) had late grade 3 toxicities. Thirteen patients experienced ovarian transposition; of these, 10 patients (77%) maintained ovarian function. Forty-one patients (71%) were alive at the last follow-up.ConclusionsConcurrent cisplatin chemotherapy with postoperative EF-IMRT was safe and well tolerated. The acute and late toxicities are acceptable. The locoregional control rates are hopeful, although distant metastases continue to be the primary mode of failure. Postoperative EF-IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.

scholarly journals Moderately Hypofractionated Intensity Modulated Radiation Therapy with Simultaneous Integrated Boost for Prostate Cancer: Five-Year Toxicity Results from a Prospective Phase I/II Trial

2020 ◽  
Author(s):  
Anthony Ricco ◽  
Nitai Mukhopadhyay ◽  
Xiaoyan Deng ◽  
Diane Holdford ◽  
Vicki Skinner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Phase I ◽  
Intensity Modulated Radiation Therapy ◽  
Prevalence Rates ◽  
Intensity Modulated ◽  
Integrated Boost ◽  
Grade 3 ◽  
Moderate Hypofractionation

Abstract Background In this phase I/II trial, five-year physician-assessed toxicity and patient reported quality of life data is reported for patients undergoing moderately hypofractionated intensity modulated radiation therapy (IMRT) for prostate cancer using a simultaneous integrated boost (SIB) and pelvic lymph node (LN) coverage. Materials and Methods Patients with T1-T2 localized prostate cancer were prospectively enrolled, receiving risk group based coverage of prostate +/- seminal vesicles (SVs) +/- pelvic lymph nodes (LNs). Low risk (LR) received 69.6 Gy/29 fractions to the prostate, while intermediate risk (IR) and high risk (HR) patients received 72Gy/30fx to the prostate and 54Gy/30fx to the SVs. If predicted risk of LN involvement > 15%, 50.4Gy/30fx was delivered to pelvic LNs. Androgen deprivation therapy was given to IR and HR patients. Results There were 55 patients enrolled and 49 patients evaluable at a median follow up of 60 months. Included were 11 (20%) LR, 23 (41.8%) IR, and 21 (38.2%) HR patients. Pelvic LN treatment was given in 25 patients (51%). Prevalence rates of late grade 2 GI toxicity at 1, 3, and 5 years was 5.8%, 3.9%, and 5.8% respectively, with no grade 3 events. Prevalence rates of late grade 2 GU toxicity at 1, 3, and 5 years rates were 15.4%, 7.7%, and 13.5% respectively, with three grade 3 events (5.8%). The biochemical relapse free survival at 5 years was 88.3%. There were no local, regional, or distant failures, with all patients still alive at last follow up. Conclusions Moderate hypofractionation of localized prostate cancer utilizing a SIB technique and LN coverage produces tolerable acute/late toxicity. Given equivalent efficacy between moderate hypofractionation schedules, the optimal regimen will be determined by long-term toxicity reported from both the physician and patient perspective.

scholarly journals Comparison of Local Recurrence With Conventional and Intensity-Modulated Radiation Therapy for Primary Soft-Tissue Sarcomas of the Extremity

2014 ◽  
Vol 32 (29) ◽  
pp. 3236-3241 ◽  
Author(s):  
Michael R. Folkert ◽  
Samuel Singer ◽  
Murray F. Brennan ◽  
Deborah Kuk ◽  
Li-Xuan Qin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Tumor Size ◽  
Intensity Modulated Radiation Therapy ◽  
External Beam Radiation ◽  
Preoperative Radiation ◽  
Beam Radiation ◽  
Intensity Modulated

Purpose The use of intensity-modulated radiation therapy (IMRT) in the treatment of soft tissue sarcoma (STS) of the extremity is increasing, but no large-scale direct comparison has been reported between conventional external-beam radiation therapy (EBRT) and IMRT. Methods Between January 1996 and December 2010, 319 consecutive adult patients with primary nonmetastatic extremity STS were treated with limb-sparing surgery and adjuvant radiotherapy (RT) at a single institution. Conventional EBRT was used in 154 patients and IMRT in 165 with similar dosing schedules. Median follow-up time for the cohort was 58 months. Results Treatment groups were comparable in terms of tumor location, histology, tumor size, depth, and use of chemotherapy. Patients treated with IMRT were older (P = .08), had more high-grade lesions (P = .05), close (< 1 mm) or positive margins (P = .04), preoperative radiation (P < .001), and nerve manipulation (P = .04). Median follow-up was 90 months for patients treated with conventional EBRT and 42 months for patients treated with IMRT. On multivariable analysis adjusting for patient age and tumor size, IMRT retained significance as an independent predictor of reduced LR (hazard ratio = 0.46; 95% CI, 0.24 to 0.89; P = .02). Conclusion Despite a preponderance of higher-risk features (especially close/positive margin) in the IMRT group, IMRT was associated with significantly reduced local recurrence compared with conventional EBRT for primary STS of the extremity.

Extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy for cervical cancer with para-aortic lymph nodes metastasis

2018 ◽  
Vol 49 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Xiaoliang Liu ◽  
Weiping Wang ◽  
Qingyu Meng ◽  
Fuquang Zhang ◽  
Ke Hu
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Field Intensity ◽  
Intensity Modulated Radiation Therapy ◽  
Concurrent Chemotherapy ◽  
Intensity Modulated ◽  
Genitourinary Toxicity ◽  
Extended Field ◽  
Grade 3

Abstract Objective This study was conducted to evaluate the efficacy and toxicity of extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy in patients with cervical cancer with positive para-aortic lymph nodes (PALN). Methods From September 2007 to December 2014, a total of 59 patients who had cervical cancer with para-aortic lymph node metastasis were treated with concurrent chemoradiotherapy at our institution. A dose of 45–50.4 Gy in 25–28 fractions with extended-field intensity-modulated radiation therapy was prescribed to planning target volume, and a dose of 30–36 Gy in 5–6 fractions was prescribed to Point A with high-dose-rate brachytherapy. A concurrent first-line cisplatin-based chemotherapy regimen was used. Results The median duration of follow-up was 32.1 months (range, 3.2–103.7 months). The 2- and 3-year overall survival, disease-free survival and local control rates were 69.0 and 52.8%, 45.0 and 41.3% and 83.4 and 81.0%, respectively. Distant metastasis was the major pattern of treatment failure, which occurred in 26 patients (44.1%). The incidence of Grade 3 or greater acute hematologic, gastrointestinal and genitourinary toxicity was 50.9, 1.7 and 3.4%, respectively. Only one patient had both Grade 3 late gastrointestinal and genitourinary toxicity. Conclusions The study found that extended-field intensity-modulated radiation therapy combined with concurrent chemotherapy was safe and effective in patients who had cervical cancer with positive PALN.

Comparative outcomes for 3D conformal versus intensity modulated radiation therapy for esophageal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 76-76
Author(s):  
Jessica Freilich ◽  
Michael Chuong ◽  
Binglin Yue ◽  
William J. Fulp ◽  
Yazan Asad Abuodeh ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Univariate Analysis ◽  
Intensity Modulated Radiation Therapy ◽  
Stage I ◽  
Tumor Length ◽  
Intensity Modulated ◽  
Significant Difference ◽  
Grade 3

76 Background: Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. Methods: We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. Results: We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (29 vs. 32 months; p=0.78) or median relapse free survival (RFS) (20 vs. 25 months; p=0.74). On multivariable analysis (MVA), not undergoing surgical resection resulted in worse OS (HR 2.255; p <0.0001) and RFS (HR 1.893; p<0.0001). Superior OS was associated on MVA with stage I/II disease (HR 0.523; p=0.010) and tumor length ≤5 cm (HR 0.567; p=0.006). Improved RFS on MVA was associated with stage I/II disease (HR 0.663; p=0.070), tumor length ≤5 cm (HR 0.611; p=0.011), adenocarcinoma histology (HR 0.532; p=0.055), and 3DCRT(HR 0.524; p=0.002). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6%+4.3% vs 9%+7.4%, p=0.0001) and on MVA with a decrease in objective grade ≥ 3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; p=0.050). Conclusions: Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.

Delivering a third course of radiation to spine metastases using image-guided, intensity-modulated radiation therapy

2013 ◽  
Vol 18 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Evangelia Katsoulakis ◽  
Nadeem Riaz ◽  
Brett Cox ◽  
James Mechalakos ◽  
Joan Zatcky ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Median Time ◽  
Local Control ◽  
Cauda Equina ◽  
Intensity Modulated Radiation Therapy ◽  
Image Guided ◽  
Intensity Modulated ◽  
Grade 3

Object The objective of this study was to investigate the feasibility and safety of delivering a third course of radiation to patients with multiply recurrent metastatic disease to the spine. Methods Between 2009 and 2011, 10 patients received a third course of radiation to spinal metastases at Memorial Sloan–Kettering Cancer Center using image-guided intensity-modulated radiation therapy (IMRT). Patient and tumor characteristics, dosimetry details, and outcomes were obtained using retrospective chart review. Spinal imaging was performed prior to treatment and at regular follow-up intervals. The cumulative biologically effective dose (BED) to the spinal cord and cauda equina was calculated and was normalized to 2 Gy equivalents (Gy2/2). Toxicity and local control were assessed. Results The median time between the first and second courses of radiation was 18.5 months and the median time between the second and third courses was 11.5 months. The median follow-up from the third course of radiation was 12 months and the median overall survival was 13 months. Pain or neurological symptoms were improved in 80% of patients. The median spinal cord maximum dose normalized BED (nBED) for the whole cohort was 70.73 Gy2/2 (range 51.9–101.7 Gy2/2). The median dose to 5% of the spinal cord D05 nBED for the entire cohort was 59.4 Gy2/2. Acute toxicity was most commonly fatigue and dermatitis, with 1 patient experiencing Grade 3 fatigue and 1 patient Grade 3 dermatitis. Late toxicity was limited to 2 cases of Grade 1 dysphagia. There was 1 case of Grade 1 neuropathy and 1 case of Grade 2 neuropathy. The crude rate of local control was 80% with 1 in-field failure and 1 marginal failure. Conclusions In this cohort of patients, a third course of IMRT to the spine was well tolerated with no significant late toxicities. Used as salvage therapy for select patients, a third course of radiation is a safe and effective treatment strategy.

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