TY - JOUR T1 - Research on the Early Side Effects and Therapeutic Results of Extended Field‐Intensity Modulated Radiation Therapy for Patients with Cervical Cancer who have Para‐Aortic Nodal Metastases AU - Nivya, M. AU - Jayakumar, K.L. JO - Research Journal of Medical Sciences VL - 18 IS - 10 SP - 610 EP - 615 PY - 2024 DA - 2001/08/19 SN - 1815-9346 DO - makrjms.2024.10.610.615 UR - https://makhillpublications.co/view-article.php?doi=makrjms.2024.10.610.615 KW - EF‐IMRT KW - PALN KW - NACT KW - cervical cancer AB -

In cervical cancer patients with para‐aortic lymph nodal metastasis, extended‐field radiotherapy (EFRT) with concurrent chemotherapy is a standard treatment. EFRT with Intensity Modulated RT (IMRT) has been shown to lessen toxicities, yet the dose thresholds which minimize acute toxicity are unknown. The present study was undertaken to review early toxicity with EF‐IMRT for carcinoma of the cervix in our patients and identify dose‐volume parameters associated with $grade II hematological toxicity and diarrhoea. We conducted a retrospective analysis of consecutive cervical cancer patients treated with EF‐IMRT for Para aortic lymph node metastasis. Patients were treated with rotational IMRT+/‐ NACT and/or concurrent chemotherapy (45‐50 Gy/25#/5 weeks) and HDR‐brachy therapy Varying doses to bowel and marrow were associated with acute hematological and gastrointestinal (diarrhoea and vomiting) toxicity. Receiver operator characteristics curves were used to derive thresholds predicting increased toxicity and tested on univariate and multi variate analysis. Finally, the disease free and overall survival (DFS and OS) were calculated. We included a total of 30 patients, the patients that received neo adjuvant chemotherapy (NACT) were 1/4 and the concurrent chemotherapy was 88%. In NACT and up front EF‐IMRT, 22.6% and 9.7% of patients respectively experienced grade $III hematological (HT) and gastrointestinal (GI) toxicity (HT increase in patients receiving NACT [($grade III HT =67% (p=0.001)]. Higher $90% at 10 Gy in entire cohort bone marrow Volume receiving 10 Gy (V10>90%) was associated with development of $grade III HT (p=0.05). For GI toxicity, no dose volume thresholds could be validated. The median OS and DFS at 2 years was 56% and 54% respectively. EF‐IMRT has acceptable grade III toxicity and is a viable treatment option for patients with cervical cancer who have para‐aortic lymph nodal involvement. Future research must concentrate on reducing the toxicity of HT.

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