10. Toxicity of chemoradiation using volumtric modulated arc therapy following 3D brachytherapy in cervical cancer

Dang Thi Van Anh, To Anh Dung, Tran Thi Huyen, Dao Thi Thanh Nhan, Bui Van Giang, Phung Thi Huyen

Main Article Content

Abstract

This study described the toxicity of chemoradiation using VMAT technique and 3D image-guided brachytherapy used to treat locally advanced cervical cancer. A total of 73 patients with stage IB3 - IIIC2 (FIGO 2018) were treated with chemoradiation with weekly cisplatin and radiation therapy using the VMAT technique and 3D image-guided brachytherapy following protocol EMBRACE II. Acute toxicity and late morbidity were assessed by CTCAE v5.0. Acute toxicities including anorexia, nausea, vomiting, diarrhea, fatigue, insomnia, thrombocytopenia, elevated AST/ALT, and elevated creatinine mostly were grades 1 and 2. Grade 3 and 4 neutropenia was observed in 24 patients (32.9%) and did not interrupt treatment. The extended field radiation therapy did not significantly increase toxicity. There was an association between some acute toxicities and the dose-volume of organs at risk. There was a low rate of late morbidity at a median of 9 months after treatment. In conclusion, the toxicity of chemoradiation using the VMAT technique and 3D image-guided brachytherapy was mainly mild, moderate, and can be tolerated.

Article Details

References

1. Cancer today. Accessed July 15, 2022. http://gco.iarc.fr/today/home.
2. Nguyen SM, Deppen S, Nguyen GH, Pham DX, Bui TD, Tran TV. Projecting Cancer Incidence for 2025 in the 2 Largest Populated Cities in Vietnam. Cancer Control. 2019; 26(1): 1073274819865274. doi:10.1177/1073274819865274.
3. NCI Urges Chemo-RT Combination for Invasive Cervical Cancer. 1999; 8(4). Accessed August 13, 2022. https://www.cancernetwork.com/view/nci-urges-chemo-rt-combination-invasive-cervical-cancer.
4. Green J, Kirwan J, Tierney J, et al. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database Syst Rev. 2005; (3): CD002225. doi:10.1002/14651858.CD002225.pub2.
5. Ramey SJ, Asher D, Kwon D, et al. Delays in definitive cervical cancer treatment: An analysis of disparities and overall survival impact. Gynecol Oncol. 2018; 149(1): 53-62. doi:10.1016/j.ygyno.2017.12.010.
6. Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A Systematic Review and Meta-Analysis of Individual Patient Data From 18 Randomized Trials. J Clin Oncol. 2008; 26(35): 5802-5812. doi:10.1200/JCO.2008.16.4368.
7. Mayadev JS, Ke G, Mahantshetty U, Pereira MD, Tarnawski R, Toita T. Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. Int J Gynecol Cancer. 2022; 32(3): 436-445. doi:10.1136/ijgc-2021-003001.
8. Pötter R, Tanderup K, Kirisits C, et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018; 9: 48-60. doi:10.1016/j.ctro.2018.01.001.
9. International Commission on Radiation Units and Measurements. Journal of the ICRU. 2013; 13(1-2): NP.2-NP. doi:10.1093/jicru/ndw028.
10. Common Terminology Criteria for Adverse Events (CTCAE). Published online 2017: 155.
11. Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 2008; 35(1): 310-317. doi:10.1118/1.2818738.
12. Seppenwoolde Y, Majercakova K, Buschmann M, et al. Early morbidity and dose–volume effects in definitive radiochemotherapy for locally advanced cervical cancer: a prospective cohort study covering modern treatment techniques. Strahlenther Onkol. 2021; 197(6): 505-519. doi:10.1007/s00066-021-01781-6.
13. Renard-Oldrini S, Guinement L, Salleron J, et al. [Dosimetric comparaison between VMAT and tomotherapy with para-aortic irradiation for cervix carcinoma]. Cancer Radiother. 2015; 19(8): 733-738. doi:10.1016/j.canrad.2015.05.031.
14. Bai W, Kou C, Yu W, et al. Dosimetric comparison of volumetric-modulated arc therapy and intensity-modulated radiation therapy in patients with cervical cancer: a meta-analysis. Onco Targets Ther. 2018; 11: 7179-7186. doi:10.2147/OTT.S178336.
15. Toita T, Kitagawa R, Hamano T, et al. Feasibility and acute toxicity of Concurrent Chemoradiotherapy (CCRT) with high-dose rate intracavitary brachytherapy (HDR-ICBT) and 40-mg/m2 weekly cisplatin for Japanese patients with cervical cancer: results of a Multi-Institutional Phase 2 Study (JGOG1066). Int J Gynecol Cancer. 2012; 22(8): 1420-1426. doi:10.1097/IGC.0b013e3182647265.
16. Ikushima H, Osaki K, Furutani S, et al. Chemoradiation therapy for cervical cancer: toxicity of concurrent weekly cisplatin. Radiat Med. 2006; 24(2): 115-121. doi:10.1007/BF02493277.
17. Zhou P, Zhang Y, Luo S, Zhang S. Pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis. Radiother Oncol. 2021; 165: 103-118. doi:10.1016/j.radonc.2021.10.015.
18. Kumar T, Schernberg A, Busato F, et al. Correlation between pelvic bone marrow radiation dose and acute hematological toxicity in cervical cancer patients treated with concurrent chemoradiation. Cancer Manag Res. 2019; 11: 6285-6297. doi:10.2147/CMAR.S195989.
19. Huang X, Fang M, Zhu L, et al. Clinical Observation of Prophylactic Extended-Field Intensity-Modulated Radiation Therapy with Synchronous Chemotherapy in Locally Advanced Cervical Cancer. Med Sci Monit. 2021; 27: e930457. doi:10.12659/MSM.930457.
20. Reijtenbagh DMW, Godart J, Mens JWM, Heijkoop ST, Heemsbergen WD, Hoogeman MS. Patient-reported acute GI symptoms in locally advanced cervical cancer patients correlate with rectal dose. Radiotherapy and Oncology. 2020; 148: 38-43. doi:10.1016/j.radonc.2020.03.035.
21. Pötter R, Tanderup K, Schmid MP, et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. The Lancet Oncology. 2021; 22(4): 538-547. doi:10.1016/S1470-2045(20)30753-1.