Abstract
Objective:Although diabetes is a common co-morbidity in patients with gynecologic cancer, information about its impact on radiation toxicity in patients with gynecologic cancer treated with external pelvic irradiation is scarce. We aimed to investigate the relation of diabetes with acute toxicity in patients with gynecologic tumors who underwent pelvic +/- paraaortic radiotherapy.Materials and Methods:One hundred twenty-nine patients with endometrium or cervix carcinoma were enrolled in the study. Demographic features, presence of diabetes, incidence and severity of upper gastrointestinal (UGIS), lower gastrointestinal (LGIS), and urinary symptoms were recorded from files. Correlation and logistic regression analysis was used to determine the impact of diabetes, age, chemotherapy, paraaortic irradiation on toxicities, and a prediction model was developed.Results:The median age of 77 patients with endometrium cancer and 52 cervix cancer was 61 (range, 25-92) years, and 28 (21.7%) of them had diabetes. The median pelvic and tumor/tumor bed dose was 5040+247.65 cGy and 5040+222.91 cGy, respectively. Age and Gr 0 UGIS toxicity were significantly related (p=0.047). LGIS Gr 0 toxicity was found to be significantly higher in patients with diabetes (p=0.045). Gr 0 and 2 UGIS toxicities were both found to be significantly correlated with paraaortic irradiation (both p<0.001). Diabetes is also an important determinant on UGIS toxicity in patients who underwent paraaortic irradiation.Conclusion:The correlation we found between toxicity and diabetes, concurrent chemotherapy or paraaortic radiation necessitates special care and risk stratification for patients with diabetes. Further prospective studies with long follow-up and larger patient groups are warranted.
Highlights
Diabetes is one of the common comorbidities in patients with cancer, leading to long-term complications[1]
Objective: diabetes is a common co-morbidity in patients with gynecologic cancer, information about its impact on radiation toxicity in patients with gynecologic cancer treated with external pelvic irradiation is scarce
We aimed to investigate the relation of diabetes with acute toxicity in patients with gynecologic tumors who underwent pelvic +/- paraaortic radiotherapy
Summary
Diabetes is one of the common comorbidities in patients with cancer, leading to long-term complications[1]. Normal lung tissue toxicity in terms of radiation pneumonitis is proved to be higher in diabetic patients with lung cancer[2,3,4,5]. In patients with prostate cancer treated with pelvic radiotherapy, the association of a high incidence and highgrade incontinence and sexual function[7], other genitourinary symptoms[8] with diabetes has been reported. The effect of diabetes on radiation toxicity has been the subject of debate in many studies with patients with prostate carcinoma. It has not been investigated in gynecologic tumors; we aimed to determine whether diabetes had any impact on the acute radiation adverse effects of women who underwent pelvic radiation therapy for gynecologic malignancies
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