Chemoradiation related acute morbidity in carcinoma cervix and correlation with hematologic toxicity: a South Indian prospective study.

Aswathy Kumaran,Lavanya Rai,Shyamala Guruvare,Shripad Hebbar,Krishna Sharan

doi:10.7314/apjcp.2014.15.11.4483

Abstract

To assess chemoradiation related acute morbidity in women with carcinoma cervix and to find and correlation between hematologic toxicity and organ system specific damage. A prospective study was carried out between August 2012 and July 2013 enrolling 79 women with cancer cervix receiving chemo-radiotherapy. Weekly assessment of acute morbidity was done using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4 and the toxicities were graded. Anemia [77 (97.5%)], vomiting [75 (94.8%)] and diarrhea [72 (91.1%)], leukopenia [11 (13.9%)], cystitis [28 (35.4%], dermatitis [19 (24.1%)] and fatigue [29 (36.71%)] were the acute toxicities noted. The toxicities were most severe in 3rd and 5th week. All women could complete radiotherapy except two due to causes unrelated to radiation morbidity; seven (8.86%) had to discontinue chemotherapy due to leukopenia and intractable diarrhea. Though there was no correlation between anemia and other toxicities, it was found that all with leukopenia had diarrhea. Chemoradiation for cancer cervix is on the whole well tolerated. Leukopenia and severe diarrhea were the acute toxicities that compelled discontinuation of chemotherapy in two women. Though anemia had no correlation with gastrointestinal toxicity, all of those with leukopenia had diarrhea.

Highlights

Chemoradiation is the current standard of care in patients with locally advanced carcinoma cervix
Extensive literature is available on the acute morbidity due to chemoradiotherapy in women with cancer cervix, most of the studies have been done at carefully prepared academic centers in developed countries (Rose et al, 1999; Maduro et al, 2003; Ikushima et al, 2006; Mahantshetty et al, 2010; Khalid et al, 2012)
We noted that leukopenia was responsible for Chemoradiation with platinum compounds Cisplatin/ Carboplatin as the chemosensitiser is the current first line treatment modality for cancer cervix stage IIA and above

Summary

Introduction

Chemoradiation is the current standard of care in patients with locally advanced carcinoma cervix. Extensive literature is available on the acute morbidity due to chemoradiotherapy in women with cancer cervix, most of the studies have been done at carefully prepared academic centers in developed countries (Rose et al, 1999; Maduro et al, 2003; Ikushima et al, 2006; Mahantshetty et al, 2010; Khalid et al, 2012). In this study we analyzed the chemoradiation induced acute morbidity in women with cancer cervix in our set up using the latest National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4 scoring system (NCI, NIH publication 2009). The objectives of this study were to assess the chemoradiation related acute morbidity in women of South Indian ethnicity with carcinoma cervix and to see if there is any correlation between hematologic toxicity and organ system specific toxicity

Objectives

Methods

Results

Conclusion