Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):408-14. doi: 10.1016/j.ijrobp.2011.12.020. Epub 2012 Feb 28.
To report on toxicity after postoperative intensity-modulated arc therapy (IMAT) for cervical (CC) and endometrial cancer (EC).
Twenty-four CC and 41 EC patients were treated with postoperative IMAT. If indicated, para-aortic lymph node irradiation (preventive or when affected, PALN) and/or concomitant cisplatin (40 mg/m(2), weekly) was administered. The prescribed dose for IMAT was 45 Gy (CC, 25 fractions) and 46 Gy (EC, 23 fractions), followed by a brachytherapeutic boost if possible. Radiation-related toxicity was assessed prospectively. The effect of concomitant cisplatin and PALN irradiation was evaluated.
Regarding acute toxicity (n = 65), Grade 3 and 2 acute gastrointestinal toxicity was observed in zero and 63% of patients (79% CC, 54% EC), respectively. Grade 3 and 2 acute genitourinary toxicity was observed in 1% and 18% of patients, respectively. Grade 2 (21%) and 3 (12%) hematologic toxicity (n = 41) occurred only in CC patients. Seventeen percent of CC patients and 2% of EC patients experienced Grade 2 fatigue and skin toxicity, respectively. Adding cisplatin led to an increase in Grade >2 nausea (57% vs. 9%; p = 0.01), Grade 2 nocturia (24% vs. 4%; p = 0.03), Grade ≥ 2 hematologic toxicity (38% vs. nil, p = 0.003), Grade ≥ 2 leukopenia (33% vs. nil, p = 0.009), and a strong trend toward more fatigue (14% vs. 2%; p = 0.05). Para-aortic lymph node irradiation led to an increase of Grade 2 nocturia (31% vs. 4%, p = 0.008) and a strong trend toward more Grade >2 nausea (44% vs. 18%; p = 0.052). Regarding late toxicity (n = 45), no Grade 3 or 4 late toxicity occurred. Grade 2 gastrointestinal toxicity, genitourinary toxicity, and fatigue occurred in 4%, 9%, and 1% of patients. Neither concomitant cisplatin nor PALN irradiation increased late toxicity rates.
Postoperative IMAT for EC or CC is associated with low acute and late toxicity. Concomitant chemotherapy and PALN irradiation influences acute but not late toxicity.
报告宫颈癌（CC）和子宫内膜癌（EC）术后调强弧形治疗（IMAT）后的毒性。
24 例 CC 和 41 例 EC 患者接受术后 IMAT 治疗。如果有指征，行预防性或受影响的腹主动脉旁淋巴结照射（PALN）和/或同期顺铂（40mg/m2，每周）。IMAT 的规定剂量为 45Gy（CC，25 次）和 46Gy（EC，23 次），如果可能，随后进行近距离放疗加量。前瞻性评估放射相关毒性。评估同期顺铂和 PALN 照射的效果。
关于急性毒性（n=65），79%的 CC 患者和 54%的 EC 患者出现 0 级和 63%的 3 级急性胃肠道毒性，分别为 1%和 18%的患者出现 3 级和 2 级急性泌尿生殖系统毒性。仅 CC 患者出现 21%的 2 级和 12%的 3 级血液学毒性（n=41）。17%的 CC 患者和 12%的 EC 患者出现 2 级疲劳和皮肤毒性。加用顺铂导致>2 级恶心（57% vs. 9%；p=0.01）、2 级夜尿症（24% vs. 4%；p=0.03）、≥2 级血液学毒性（38% vs. 无，p=0.003）、≥2 级白细胞减少症（33% vs. 无，p=0.009）和疲劳增加的趋势更为明显（14% vs. 2%；p=0.05）。腹主动脉旁淋巴结照射导致 2 级夜尿症（31% vs. 4%，p=0.008）和>2 级恶心增加的趋势更为明显（44% vs. 18%；p=0.052）。关于晚期毒性（n=45），无 3 级或 4 级晚期毒性。4%、9%和 1%的患者出现 2 级胃肠道毒性、泌尿生殖系统毒性和疲劳。同期顺铂或 PALN 照射并未增加晚期毒性发生率。
EC 或 CC 的术后 IMAT 具有低急性和晚期毒性。同期化疗和 PALN 照射影响急性毒性，但不影响晚期毒性。
