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Radiotherapy dose escalation with concurrent chemotherapy in locally advanced cervix cancer is feasible

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Abstract

Background

To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity.

Methods

Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment.

Results

Mean age was 46 (30–63) and 47 years (33–67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I–II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I–III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity.

Conclusion

VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT “Box”. We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT.

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Authors and Affiliations

  1. Department of Radiation Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Centre, MBC 64, PO Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia

    M. W. Hegazy & R. I. Mahmood

  2. Department of Clinical Oncology and Nuclear Medicine, Zagazig Faculty of Medicine, Zagazig, Egypt

    M. W. Hegazy

  3. Department of Gynaecologic Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    I. A. Al-Badawi

  4. Department of Biomedical Physics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    B. Moftah

  5. Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    H. AlHusaini

Authors
  1. M. W. Hegazy
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  2. R. I. Mahmood
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  3. I. A. Al-Badawi
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  4. B. Moftah
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  5. H. AlHusaini
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Corresponding author

Correspondence to R. I. Mahmood.

Ethics declarations

This study has been approved by the institutional ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to therapy; however, for retrospective review of data with less than minimal risk to the patients, no consent was required by the ethics committee. All authors declare that there is no conflict of interest.

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Hegazy, M.W., Mahmood, R.I., Al-Badawi, I.A. et al. Radiotherapy dose escalation with concurrent chemotherapy in locally advanced cervix cancer is feasible. Clin Transl Oncol 18, 58–64 (2016). https://doi.org/10.1007/s12094-015-1336-5

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  • DOI: https://doi.org/10.1007/s12094-015-1336-5

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