A Prospective Randomized Study of Intensity-Modulated Radiation Therapy Versus Three-Dimensional Conformal Radiation Therapy With Concurrent Chemotherapy in Locally Advanced Carcinoma Cervix.

Nidhi Sharma,Ajay S Krishnan,Rajesh Pasricha,Deepa Joseph,Manoj Gupta,Rachit Ahuja,Sagar Raut,Aathira T S,Debanjan Sikdar,Sweety Gupta

doi:10.7759/cureus.21000

Abstract

Background: External Beam Radiotherapy is the treatment of choice of locally advanced carcinoma cervix (LACC). The two techniques, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), have been compared previously in terms of outcomes and toxicities. IMRT has still not shown any benefit over 3DCRT in terms of local control and survival. Hence, the present study was conducted to compare local control and toxicities among both techniques.Material & Methods: Fifty-four patients of LACC (FIGO IB2-IVA) were randomized to receive 50 Gray in 25 fractions by either 3DCRT or IMRT with concurrent cisplatin-based chemotherapy followed by brachytherapy. Plans were compared for planning target volume (PTV) coverage, dose to organs at risk (OAR), homogeneity index (HI), and conformity index (CI). Patients were assessed for acute toxicity and local control for three months.Results: Out of 54 patients, 27 received treatment by 3DCRT and 27 by IMRT technique. Dosimetric evaluation for PTV coverage was similar in both arms. D15, D35, and D50 (dose to 15%, 35%, and 50% volume, respectively) for bladder were significantly reduced in the IMRT arm. Dosimetry for rectum and bowel bag was similar in both. There was a significantly decreased dose to femoral heads in the IMRT arm. Patients in the 3DCRT arm had significant grade 1 and 2 anemia and neutropenia compared to the IMRT arm. Local control for three months was similar in both the arms.Conclusion: IMRT is associated with decreased acute hematological toxicity compared to 3DCRT with similar local control. Long-term follow-up is needed to assess any difference in long-term toxicity and survival between the two arms.

Highlights

Cervical cancer remains the most common gynecologic cancer worldwide, with >500,000 women with cervical carcinoma and 233,000 women dying of the disease annually [1]
D15, D35, and D50 for bladder were significantly reduced in the intensity-modulated radiotherapy (IMRT) arm
Patients in the 3DCRT arm had significant grade 1 and 2 anemia and neutropenia compared to the IMRT arm

Summary

Introduction

Cervical cancer remains the most common gynecologic cancer worldwide, with >500,000 women with cervical carcinoma and 233,000 women dying of the disease annually [1]. External beam radiotherapy (EBRT) with concurrent chemotherapy and intracavitary brachytherapy remains the mainstay treatment for locally advanced carcinoma cervix (LACC). EBRT can be delivered using twodimensional radiotherapy (2DRT), three-dimensional conformal radiotherapy (3DCRT), or intensitymodulated radiotherapy (IMRT). IMRT is associated with more accurate dose distributions and reduced dose to organs at risk (OARs), reducing side effects to the rectum, bladder, small bowel, and pelvic bones [36]. External Beam Radiotherapy is the treatment of choice of locally advanced carcinoma cervix (LACC). The two techniques, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), have been compared previously in terms of outcomes and toxicities. IMRT has still not shown any benefit over 3DCRT in terms of local control and survival. The present study was conducted to compare local control and toxicities among both techniques

Methods

Results

Conclusion