ESTRO meets Asia 2024 - Abstract Book

S149

Interdisciplinary – Gynaecological

ESTRO meets Asia 2024

Shalini Singh 1 , Satya Sadhan Sarangi 2 , Shreshtha Jaiswal 1 , S K Senthil Kumar 1 , Prabhakar Mishra 3

1 Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. 2 Med. Oncology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. 3 Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Purpose/Objective:

The encouraging results of weekly dose dense NACT-CRT study and increasing waiting time on machines to start definitive CRT in our region, the present pilot study was proposed to assess the compliance, toxicities, response and the quality of life (QoL) in locally advanced cervical cancer patients treated by NACT followed by standard CRT. A three weekly NACT schedule was chosen for study which was considered to have less logistics issues to the patient anticipating better compliance by decreasing the financial burden on the patients in this lower middle income country.

Material/Methods:

Histopathologically proven cancer cervix patients, >18years, FIGO stage (2009) IB2-IVA, Karnofsky performance status ≥ 70 with adequate haematological, biochemistry functions and suitable for radical treatment were considered. 30 patients consented for the prospective study were included after obtaining ethical clearance. Patients received NACT as Inj. paclitaxel 175mg/m 2 and Inj. cisplatin 75mg/m 2 x 2cycles as 3 weekly schedules. Radiation therapy was started within 2weeks of completion of NACT with concurrent platin based chemotherapy once the haematological counts were normal. All patients were planned by 6MV/15MV photon beams by 3D conformal technique using linear accelerator to a dose of 45-50.40Gy/ 25-28 fractions/5-5.5weeks.. Planning target volume was expanded uniformly 1cm from clinical target volume. Following completion of CRT, patient received high dose rate (HDR) brachytherapy to a total of 7Gy per fraction for 3 fractions. In case of gross residual disease or narrowed vagina, interstitial brachytherapy application to a dose of 6Gy/fraction x 4 fractions was undertaken .Every effort was made to keep the overall treatment time (CRT+ brachytherapy) to< 8weeks. Acute and late toxicities during NACT, CRT and follow-up were documented as per Common Terminology Criteria for Adverse Events v4.0 (CTCAE). Overall quality of life was measured with EORTC Core questionnaire (QLQ-C30 and CX24) prior to start of treatment i.e., baseline, before start of CRT, at completion of treatment (CRT+brachytherapy) and at follow-up time-points of 3, 6, 9, 12months The median age was 53 years. 53% had FIGO stage III. 27/30 patients (90%) received planned 2 cycles of NACT. The overall clinical response rate post NACT was 76% with complete response in 1 (3%) patient. 29/30 completed planned RT with 90% receiving concurrent CT with a median 5 cycles. The median time for completion of RT was 41 days (range 35-52). The median treatment for completion of planned radiotherapy (RT + Brachytherapy) was 56 days. At 3 months post treatment, overall response rate was 94% with 25/30 (84%) achieving a complete response locally clinically and radiologically. NACT was well tolerated with 11% experiencing any grade 3/4 toxicities and no treatment-related deaths. During CRT grade 3/4 hematological and non-haematological toxicities was seen in 4% and 7% respectively. The 1 year Local disease free, distant disease and OS were 80%, 79% and 87% respectively while 3 year rates were 60%, 67%, 60% respectively median not reached. Results:

The mean global health score showed a significant improvement over period of time with numerical difference of 23 points from baseline (56) to post 12months (79) completion of treatment and was statistically significant