ESTRO 2024 - Abstract Book

S1017

Clinical - Gynaecology

ESTRO 2024

996

Mini-Oral

Late toxicity and outcome of hypo-fractionated pelvic RT and brachytherapy for carcinoma cervix

Ajeet Kumar Gandhi, Madhup Rastogi, Anoop Kumar Srivastava, Rohini Khurana, Rahat Hadi, Rakhi Verma, Vachaspati Kumar Mishra, Surendra Prasad Mishra

Dr Ram Manohar Lohia Institute of Medical Sciences, Radiation Oncology, Lucknow, India

Purpose/Objective:

We had earlier reported acute toxicities and early clinical outcome of locally advanced cervical carcinoma (LACC) treated with moderately hypofractionated whole pelvic radiotherapy (H-EBRT) and image guided brachytherapy [1]. Herein, we report late toxicities and mature long term clinical outcome of our prospective pilot study.

Material/Methods:

50 patients of squamous cell carcinoma of cervix were recruited in this prospective interventional trial between December 2018-December 2021 (CTRI/2018/11/016415). Patients were treated with whole pelvic radiotherapy (H EBRT) 40 Gray in 16 fractions over 3.5 weeks with boost to pelvic lymph nodes 10 Gray in 4 fractions with three dimensional conformal radiotherapy and concurrent cisplatin weekly 40 mg/m 2 followed by image guided high dose rate intracavitary/ interstitial brachytherapy 7Gray in 4 fractions. Late gastrointestinal (GI) and Genitourinary (GU) toxicities were recorded as per RTOG criteria. Overall (OS), disease free (DFS), local recurrence free (LRFS), loco-regional recurrence free (LRRFS) and distant metastasis free (DMFS) survival were estimated by Kaplan Meier method.

Results:

Median age was 50 (range 32-65) years. Median Karnofsky Performance Score was 90 (range 70-90). FIGO 2018 stage IB3:IIA2:IIB:IIIA:IIIB:IIIC1 was seen in 5 (9.5%): 4 (7.6%): 20 (37.7%) :2 (3.8%): 10 (20%): 9 (17%) patients respectively. All patients completed intended course of treatment. Median number of concurrent chemotherapy cycles were 4 (range 3-5). Median time from start to end of H-EBRT was 22 days (range 21-29 days). For 9 patients with IIIC1 disease receiving sequential nodal boost, this time was 28 days (range 28-29 days). Median overall treatment time was 50 (range 37-81) days. Median (range) cumulative equivalent dose at 2 Gray per fraction (EQD2) for D90 high risk clinical target volume, D2cc rectum, D2cc bladder and D2cc sigmoid were 80.15 (68-104.9) Gray, 65.91 (51.1 75.18) Gray, 82.05 (58.58-94.96) Gray and 55.96 (46.5-86.76) Gray respectively. Median follow up time was 45.8 (range 11.7-64.1) months. Late grade 1 GI toxicity was observed in 5 (10%) patients; altered bowel habits (2), mild diarrhea (2) and slight rectal bleeding (1). Late grade 2 GI toxicity was seen in 5 (10%) patients; intermittent rectal bleeding (4) and increased bowel movements (1). Late grade 3 GI toxicity was seen in 3 (6%) patients; all 3 with rectal bleeding necessitating packed red blood cell transfusion and/or argon plasma laser coagulation. The median EQD2 to D2cc of rectum was 67.1, 61.2, 67.4 Gray in 3 patients developing grade 3 GI toxicity. Late grade 1, 2 and 3 GU toxicities were observed in 1(2%),2(4%) and 1 (2%) patient respectively. 7 (14%) patients recurred till the time of last follow up; 2 had isolated local, 1 had loco-regional, 1 had regional, 1 had isolated distant, 2 had distant plus loco-regional