scholarly journals The Relationship Between the Radiation Dose of Different Anatomic Bony Sites and Neutrophil Toxicity in Concurrent Chemoradiotherapy for Cervical Cancer

2020 ◽  
Author(s):  
Baozhong Zhang ◽  
Liming Xu ◽  
Zhiyan Liu ◽  
Yanlan Chai ◽  
Yuanjie Cao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Dose ◽  
Linear Regression ◽  
Neutrophil Count ◽  
Concurrent Chemoradiotherapy ◽  
Pelvic Bone ◽  
High Dose ◽  
Analysis Model ◽  
Beam Radiation ◽  
Cutoff Values

Abstract Background: The purpose of this study was to verify the radiation dose of the pelvic bone marrow of different anatomical bony sitesand the incidence of neutrophil toxicity during the concurrent chemoradiotherapy for cervical cancer.Methods: There were 117 cervical cancer patients who received concurrent chemoradiotherapy included in this research. The radiotherapy includedexternal-beam radiation therapy (EBRT) and the brachytherapy. The dosimetric parameters included V5, V10, V20, V30, V40, V50, and Dmean. The final neutrophil count was defined as the lowest neutrophil count after 2 circles of concurrent chemotherapy, during or within 1 month after the treatment. The correlation between the dosimetric parameters and the lowest neutrophil count were analyzed by linear regression, the cutoff values of the dosimetric parameters were obtained using the ROC curves,the patients were divided into subgroups based on the cutoff values. The clinicopathologic features and the dosimetric parameters were included into the multivariate regression analysis model to further prove the correlation between the dosimetric parameters and the neutrophil toxicity. Data were assessed with IBM-SPSS software version 22.0, and all values of p<0.05were considered statistically significant.Results:The neutrophil toxicity (grade 1-4) rate was 58.97%. The linear regression showed the Dmean and V50 of Lumbosacral vertebrae(LS), the Dmean, V5, V10, V20, V30, V40 and V50 of the ilium correlated with the lowest neutrophil count, while none of the dosimetric parameters of the femoral correlated with the lowest neutrophil count.The multivariate analysis showed the V20, V30 and V50 of the LS, the Dmean, V5, V10, V20 and V30 of the ilium correlated well with the neutrophil toxicity; none of the dosimetric parameters of the femoral correlated with the neutrophil toxicity.Conclusion:During the process of concurrent chemoradiotherapy for cervical cancer, the volume of medium and high dose of LS and the volume of low and medium dose of ilium should be strictly limitedto reduce the risk of neutrophil toxicity, the Dmean of the ilium should also be taken into consideration. The dosimetric parameters of the femur could be ignored.Trial registration:This is a retrospective research, and it will be retrospectively registered.

scholarly journals Direct radiation dose measurement of rectum during High-Dose-Rate 192Ir brachytherapy for cervical cancer treatment

2019 ◽  
Vol 6 (0) ◽  
pp. 39-42
Author(s):  
Emi Tomita ◽  
Hiroaki Hayashi ◽  
Takashi Asahara ◽  
Kanako Sakuragawa ◽  
Yasufumi Shitakubo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Dose ◽  
Cancer Treatment ◽  
Dose Rate ◽  
High Dose Rate ◽  
High Dose ◽  
Dose Measurement ◽  
Direct Radiation

Correlation Between Changes of Pelvic Bone Marrow Fat Content and Hematological Toxicity in Concurrent Chemoradiotherapy for Cervical Cancer

2021 ◽  
Author(s):  
Cong Wang ◽  
Xiaohang Qin ◽  
Guanzhong Gong ◽  
Lizhen Wang ◽  
Ya Su ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Blood Cell ◽  
Peripheral Blood ◽  
Concurrent Chemoradiotherapy ◽  
Peripheral Blood Cell ◽  
Fat Content ◽  
Pelvic Bone ◽  
Cell Counts ◽  
Blood Cell Counts

Abstract Objectives: To quantify the pelvic bone marrow (PBM) fat content changes receiving different radiation doses of concurrent chemoradiotherapy for cervical cancer and to determine association with peripheral blood cell counts. Methods: Fifty-four patients were prospectively collected. Patients underwent MRI iterative decomposition of water and fat with echo asymmetrical and least squares estimation (IDEAL IQ) scanning at RT-Pre, RT mid-point, RT end, and six months. The changes in proton density fat fraction (PDFF%) at 5–10 Gy, 10–15 Gy, 15–20 Gy, 20–30 Gy, 30–40 Gy, 40–50 Gy, and >50 Gy doses were analyzed. Spearman’s rank correlations were performed between peripheral blood cell counts versus the differences in PDFF% at different dose gradients before and after treatment. Results: The lymphocytes (ALC) nadirs appeared at the midpoint of radiotherapy, which was only 27.6% of RT-Pre; the white blood cells (WBC), neutrophils (ANC), and platelets (PLT) nadirs appeared at the end of radiotherapy which was 52.4%, 65.1%, and 69.3% of RT-Pre, respectively. At RT mid-point and RT-end, PDFF% increased by 46.8% and 58.5%, respectively. Six months after radiotherapy, PDFF% decreased by 4.71% under 5–30 Gy compared to RT-end; while it still increased by 55.95% compared to RT-Pre. There was a significant positive correlation between PDFF% and ANC nadirs at 5–10 Gy (r = 0.62, P = 0.006), and correlation was observed between PDFF% and ALC nadirs at 5–10 Gy (r = 0.554, P = 0.017). Conclusion: MRI IDEAL IQ imaging was a non-invasive approach to evaluate and track the changes of PBM fat content with concurrent chemoradiotherapy for cervical cancer. The limitation of low-dose bone marrow irradiation volume in cervical cancer concurrent chemoradiotherapy should be paid more attention.

Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer

2004 ◽  
Vol 14 (2) ◽  
pp. 381-383
Author(s):  
H. Lin ◽  
C.-L. Chang ◽  
E.-Y. Huang ◽  
C.-C. Changchien
Keyword(s):  
Cervical Cancer ◽  
Sigmoid Colon ◽  
Concurrent Chemoradiotherapy ◽  
Tissue Injury ◽  
Gynecological Cancer ◽  
Good Condition ◽  
External Beam Radiation ◽  
Colon Perforation ◽  
Beam Radiation ◽  
Sigmoid Colon Perforation

Radiation-induced colon perforation is a rare adverse effect caused by vascular and connective tissue injury to the rectosigmoid colon. It usually occurs a few months to years after radiotherapy for gynecological cancer. Herein, we present a patient who developed sigmoid colon perforation during concurrent chemoradiotherapy for cervical cancer. The patient was a 64-year-old clinical stage IIB woman who received concurrent chemoradiotherapy as a standard treatment. The chemotherapeutic protocol was cisplatin 50 mg/m2 and 5-fluorouracil 4000 mg, starting together with radiotherapy. After the completion of external beam radiation for 4500 cGy, the patient developed sigmoid colon perforation presenting with fecal peritoneum and sepsis. An emergency end ileostomy with resection of entire sigmoid colon was performed and the patient was discharged 3 months later in good condition. Clinicians must be highly suspicious of serious bowel perforation, even if the full dose of radiation has not been completed. Whether or not the chemotherapy was the trigger factor is in need of further clarification.

Long-Term Results of a Phase II Trial of Concomitant Cisplatin-Paclitaxel Chemoradiation in Locally Advanced Cervical Cancer

2016 ◽  
Vol 26 (6) ◽  
pp. 1162-1168 ◽  
Author(s):  
María Isabel Martínez-Fernández ◽  
Jairo Legaspi Folgueira ◽  
Germán Valtueña Peydró ◽  
Mauricio Cambeiro ◽  
Jaime Espinós ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
High Dose Rate ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Long Term Results ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation

ObjectivesThe aim of this study was to determine the long-term results of a 7-week schedule of external beam radiation therapy, high dose rate brachytherapy, and weekly cisplatin and paclitaxel in patients with locally advanced carcinoma of the cervix.MethodsThirty-seven patients with International Federation of Gynecology and Obstetrics stages IB2 to IVa cervical cancer were treated with 40 mg/m2 per week of intravenous cisplatin and 50 mg/m2 per week of intravenous paclitaxel combined with 45 Gy of pelvic external beam radiation therapy and 28 to 30 Gy of high dose rate brachytherapy.ResultsSixteen patients (43.2%) were able to complete the 6 scheduled cycles of chemotherapy. The median number of weekly chemotherapy cycles administered was 5. Thirty-six (16.2%) of 222 cycles of chemotherapy were not given because of toxicity. The mean dose intensity of cisplatin was 29.6 mg/m2 per week (95% confidence interval, 27.0–32.1); that of paclitaxel was 40.0 mg/m2 per week (95% confidence interval, 36.9–43.1). Thirty-four patients (91.8%) completed the planned radiation course in less than 7 weeks. Median radiation treatment length was 43 days. After a median follow-up of 6 years, 7 patients (18.9%) experienced severe (RTOG grade 3 or higher) late toxicity. No fatal events were observed. Ten patients have failed, 1 locally and 9 at distant sites. The 14-year locoregional control rate was 96.7%, and the 14-year freedom from systemic failure rate was 64.6%. Fourteen-year actuarial disease-free survival and overall survival rates were 44.8% and 50%, respectively.ConclusionsThis study demonstrates excellent very long-term results and tolerable toxicity although the target weekly dosage of cisplatin and paclitaxel needs to be adjusted in the majority of the patients.

scholarly journals Survival in Cervical Cancer and Its Predictors at Ocean Road Cancer Institute From January to December 2012

2021 ◽  
pp. 734-739
Author(s):  
Salama Iddy Khamis ◽  
Alita S. Mrema ◽  
Johnson Katanga ◽  
Emmanuel L. Lugina
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Concurrent Chemoradiotherapy ◽  
Hemoglobin Level ◽  
Rank Test ◽  
High Dose ◽  
Hiv Status ◽  
Survival Times ◽  
Gynecology And Obstetrics ◽  
Radiotherapy Dose

PURPOSE In Tanzania, cancer of cervix is the most commonly diagnosed cancer and is the leading cause of cancer-related deaths. There are very little data about survival of patients with cervical cancer after treatment in Tanzania. The aims of this study were to determine 5-year overall survival (OS) rate and its predictors among patients with cervical cancer treated at Ocean Road Cancer Institute (ORCI) from January to December 2012. MATERIALS AND METHODS This was retrospective study done at ORCI by reviewing medical charts of 202 patients with cervical cancer treated at ORCI from January to December 2012. A structured questionnaire was used to extract information about characteristics of the respondents. Survival curves were estimated by using Kaplan-Meir analysis and were compared by using log-rank test. RESULTS The 5-year OS rate was 26%. The mean and median survival times were 33.9 and 19 months, respectively. Factors that were positively associated with 5-year OS rate include the hemoglobin level more than 9 g/dL at presentation, early International Federation of Gynecology and Obstetrics stage at presentation, high dose of radiotherapy, and use of concurrent chemoradiotherapy. Histology type and HIV status were not associated with survival. CONCLUSION The 5-year overall survival rate was 26%. Predictors of OS were hemoglobin level, stage at presentation, radiotherapy dose, and the use of concurrent chemoradiotherapy.

Radiotherapy dose escalation on pelvic lymph node control in patients with cervical cancer

2020 ◽  
pp. ijgc-2020-001342
Author(s):  
Emile Gogineni ◽  
Beatrice Bloom ◽  
Ferney Diaz Molina ◽  
Jeannine Villella ◽  
Anuj Goenka
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Radiation Dose ◽  
Lymph Nodes ◽  
Dose Escalation ◽  
Gastrointestinal Toxicity ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Node Positive

ObjectiveData supporting dose escalation for node-positive cervical cancer are currently limited to small retrospective studies. The goal of this study was to assess whether radiation dose was associated with lymph node control or gastrointestinal toxicity in patients with node-positive cervical cancer.MethodsA total of 390 patients with carcinoma of the uterine cervix were treated between October 1997 and October 2017. Patients included in our analysis were those with squamous cell carcinoma or adenocarcinoma who were node-positive, treated definitively, and with at least one follow-up visit and post-treatment imaging scan. We excluded those without follow-up and those treated with palliative intent. All patients were treated with external beam radiation to pelvic±para-aortic fields with concurrent weekly cisplatin. All lymph nodes present at the time of treatment were stratified by size as <2 cm or ≥2 cm. Acute and late gastrointestinal toxicity were recorded for all patients.ResultsA total of 77 patients with 206 lymph nodes were identified. Median stage at presentation was FIGO IIB. Thirteen patients underwent definitive surgical resection followed by adjuvant radiation, of which 12 were treated to doses ≤5040 (range 2700–5940) cGy. Sixty-four patients were treated with definitive chemoradiation, of which 42 (66%) received ≤5040 (range 4500–5040) cGy and 22 (34%) received >5040 (range 5300–6640) cGy. Patients with pre-chemoradiation lymph nodes ≥2 cm had inferior lymph node control compared with patients with pre-chemoradiation lymph node <2 cm at 12 months (77% vs 100%, p=0.002). Radiation dose >5040 cGy was not significantly associated with improved lymph node control compared with ≤5040 cGy when analyzing all patients (12 months, 100% vs 89%, p=0.112). In patients with pre-chemoradiation lymph nodes ≥2 cm, radiation dose >5040 cGy was associated with improved lymph node control (12 months, 100% vs 60%, p=0.020). Acute grade ≥2 gastrointestinal toxicity was not associated with radiation dose >5040 cGy (20% vs 13%, p=0.424). Two patients developed grade ≥2 late gastrointestinal toxicity, both of whom were treated to ≤5040 cGy.ConclusionsThis series supports the role of dose escalation for patients with lymph nodes ≥2 cm. Dose escalation is associated with improved control in patients with larger lymph nodes, and is not associated with greater gastrointestinal toxicity.

Concurrent chemoradiotherapy using high-dose-rate intracavitary brachytherapy for uterine cervical cancer

2005 ◽  
Vol 96 (3) ◽  
pp. 665-670 ◽  
Author(s):  
Takafumi Toita ◽  
Hidehiko Moromizato ◽  
Kazuhiko Ogawa ◽  
Yasumasa Kakinohana ◽  
Toshiyuki Maehama ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Dose Rate ◽  
Concurrent Chemoradiotherapy ◽  
Uterine Cervical Cancer ◽  
High Dose Rate ◽  
Intracavitary Brachytherapy ◽  
High Dose
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