Ballari N, Rai B, Bahl A, Mittal B R, Ghoshal S
Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Tech Innov Patient Support Radiat Oncol. 2021 Mar 9;17:48-56. doi: 10.1016/j.tipsro.2021.02.009. eCollection 2021 Mar.
To evaluate the treatment related acute and delayed toxicities of extended field Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients of locally advanced cervical cancer with pelvic lymph nodes.
From 2014 to 2016, 15 patients of locally advanced cervical cancer with Fluoro-deoxyglucose positron emission tomography (FDG-PET) positive pelvic lymph nodes were treated with extended field Simultaneous integrated boost (SIB)-VMAT 45 Gy/55 Gy/25#/5weeks and concurrent cisplatin. Acute toxicities were documented according to common terminology criteria for adverse events version 4 (CTCAE v.4). Dose volume parameters and patient characteristics were analyzed for association with toxicities.
Median age of patients at diagnosis was 48 years. 40% (6 patients) were stage IIB & 60% (9 patients) were stage IIIB. Median number of involved pelvic lymph nodes was 2 (range, 1-4), commonest location was external iliac lymph node region (86%). Median number of concurrent chemotherapy cycles received was five. Treatment was well tolerated and there were no grade ≥ 3 acute toxicities. Commonest acute toxicities observed were vomiting (≥grade2 -13.3%) followed by & nausea (grade ≥ 2 in 6%) and were associated with volume of bowel bag receiving 45 Gy. Constitutional symptoms (≥grade 2) were observed in 6% patients and had no dosimetric associations. At a median follow up of 43 months, delayed ≥ grade1, 2, 3 toxicity were observed in 80%, 0%, and 0% respectively with diarrhea being the commonest.
Prophylactic para aortic extended field VMAT with concurrent chemotherapy for locally advanced cervical cancer is well tolerated with acceptable acute toxicity profile. Significant grade 3 acute/delayed toxicities were not observed in this cohort of patients.
评估盆腔淋巴结转移的局部晚期宫颈癌患者接受扩大野容积调强弧形放疗（VMAT）联合同步化疗的治疗相关急性和迟发性毒性。
2014年至2016年，15例氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示盆腔淋巴结转移的局部晚期宫颈癌患者接受了扩大野同步整合加量（SIB）-VMAT 45 Gy/55 Gy/25次/5周治疗及顺铂同步化疗。根据不良事件通用术语标准第4版（CTCAE v.4）记录急性毒性。分析剂量体积参数和患者特征与毒性的相关性。
患者诊断时的中位年龄为48岁。40%（6例）为IIB期，60%（9例）为IIIB期。受累盆腔淋巴结的中位数量为2个（范围1-4个），最常见部位是髂外淋巴结区域（86%）。接受同步化疗周期的中位数量为5个。治疗耐受性良好，无≥3级急性毒性反应。观察到的最常见急性毒性反应是呕吐（≥2级-13.3%），其次是恶心（≥2级为6%），且与接受45 Gy照射的肠袋体积有关。6%的患者出现全身症状（≥2级），且与剂量学无关。中位随访43个月时，分别有80%、0%和0%的患者出现迟发性≥1级、2级和3级毒性反应，最常见的是腹泻。
盆腔淋巴结转移的局部晚期宫颈癌患者接受预防性主动脉旁扩大野VMAT联合同步化疗耐受性良好，急性毒性反应可接受。该队列患者未观察到显著的3级急性/迟发性毒性反应。
