The Clinical Course of the Late Toxicity of Definitive Radiotherapy in Cervical Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Treatments
2.3. Follow-Up and Toxicity Evaluation
2.4. Statistical Analysis
3. Results
3.1. Occurrence of Late Toxicity
3.2. Onset and Prevalence over Time after Completion of Radiotherapy
3.3. Intervention and Remission of Toxicity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | n. (%), Total = 60 |
---|---|
Modality | |
Concurrent chemoradiotherapy | 53 (88.3%) |
RT alone | 7 (11.7%) |
EBRT dose | Median, 50.4 Gy/28 fxs (range, 45–59.4 Gy/25–33 fxs) |
EBRT technique | |
4-box technique | 38 (63.3%) |
IMRT | 22 (36.7%) |
Brachytherapy prescription | |
9.6 Gy/3 fxs | 1 (1.7%) |
19 Gy/4 fxs | 1 (1.7%) |
20–22.5 Gy/5 fxs | 3 (5%) |
24 Gy/6 fxs | 14 (23.3%) |
28 Gy/7 fxs | 12 (20%) |
32 Gy/8 fxs | 3 (5%) |
25–27.5 Gy/5–6 fxs | 8 (13.3%) |
30 Gy/5 fxs | 3 (5%) |
30 Gy/6 fxs | 15 (25%) |
Cumulative EQD210 to point A | Median, 82.23 Gy10 (range, 60.12–95.3 Gy10) |
<80 Gy10 | 20 (33.3%) |
≥80 Gy10 | 40 (66.7%) |
Variable | n. (%), Total = 60 |
---|---|
Age | Median, 60 years (range, 36–84 years) |
≤45 years | 4 (6.7%) |
>45 years | 56 (93.3%) |
Menopausal status at diagnosis | |
Premenopause | 11 (18.3%) |
Menopause | 49 (81.7%) |
Regular cervix cancer screening before diagnosis † | |
Yes | 22 (36.7%) |
No | 38 (63.3%) |
Symptom due to cervix cancer at diagnosis | |
None | 14 (23.3%) |
Vaginal bleeding | 33 (55%) |
Vaginal discharge | 5 (8.3%) |
Pain | 7 (11.7%) |
Hydronephrosis | 1 (1.7%) |
Diabetes mellitus | |
Yes | 13 (21.7%) |
No | 47 (78.3%) |
Hypertension | |
Yes | 23 (38.3%) |
No | 37 (61.7%) |
Smoking | |
Smoker | 5 (8.3%) |
Non-smoker | 55 (91.7%) |
Pathology | |
Squamous cell carcinoma | 57 (95%) |
Adenocarcinoma | 2 (3.3%) |
Adenosquamous carcinoma | 1 (1.7%) |
Tumor size (maximum diameter) | Median, 4.6 cm (range, 1–10 cm) |
Pre-treatment SCC Ag | Median, 7.5 (range, 0.55–88.2) |
LN metastasis | |
Yes | 24 (40%) |
No | 36 (60%) |
FIGO stage | |
IB | 9 (15%) |
IIA | 4 (6.7%) |
IIB | 19 (31.7%) |
IIIB | 3 (5%) |
IIIC1 | 14 (23.3%) |
IIIC2 | 3 (5%) |
IVA | 8 (13.3%) |
Late Rectal Toxicity | N of pts (%) | Manifestations |
---|---|---|
G1 | 4 (6.7%) | diarrhea (n = 4) |
G2 | 9 (15%) | rectal bleeding (n = 9) |
G3 | 3 (5%) | moderate rectal bleeding (n = 3) |
G4 | 2 (3.3%) | rectovaginal fistula (n = 1), |
colovesical fistula (n = 1) | ||
Late Bladder Toxicity | ||
G1 | 4 (6.7%) | urinary incontinence (n = 1), |
dysuria (n = 1), | ||
urinary frequency (n = 2) | ||
G2 | 6 (10%) | urinary incontinence (n = 1), |
urinary frequency (n = 1), | ||
gross hematuria (n = 4) | ||
G3 | 1 (1.7%) | moderate hematuria (n = 1) |
G4 | 4 (6.7%) | hemorrhagic cystitis (n = 1), |
colovesical fistula (n = 1), | ||
vesicovaginal fistula (n = 2) |
Toxicity | Number of Patients | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
3–6 Months | 12 Months | 24 Months | 36 Months | >36 Months | ||||||
New † | P. ‡ | New | P. | New | P. | New | P. | New | P. | |
Rectum | ||||||||||
Gr 1 | 4 | 4 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 |
Gr 2 | 1 | 1 | 4 | 5 | 2 | 4 | 1 | 1 | 1 | 2 |
Gr 3 | 0 | 0 | 1 | 1 | 1 | 2 | 0 | 1 | 0 | 0 |
Gr 4 | 1 | 1 | 1 | 2 | 0 | 2 | 0 | 0 | 0 | 0 |
Total | 6 | 6 | 6 | 8 | 3 | 9 | 1 | 3 | 1 | 2 |
Bladder | ||||||||||
Gr 1 | 3 | 3 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 2 |
Gr 2 | 1 | 1 | 0 | 0 | 3 | 3 | 0 | 1 | 2 | 2 |
Gr 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 |
Gr 4 | 1 | 1 | 0 | 1 | 1 | 2 | 1 | 2 | 1 | 3 |
Total | 5 | 5 | 0 | 2 | 4 | 5 | 1 | 3 | 5 | 8 |
pts.at risk * † | 60 | 60 | 58 | 37 | 34 ** |
Toxicity | Complete Remission n. (%) | Partial Remission n. (%) | Non-Remission n. (%) |
---|---|---|---|
Lower GI † | |||
Grade 1 | 4/4 (100%) | 0/4 (0%) | 0/4 (0%) |
Grade 2 | 6/8 (75%) | 1/8 (12.5%) | 1/8 (12.5%) |
Grade 3 | 2/3 (66.7%) | 1/3 (33.3%) | 0/0 (0%) |
Grade 4 | Fistula and perforation (n.= 2); permanent damage | ||
Bladder | |||
Grade 1 | 4/4 (100%) | 0/4 (0%) | 0/4 (0%) |
Grade 2 | 5/6 (83.3%) | 1/6 (16.7%) | 0/6 (0%) |
Grade 3 | 0/1 (0%) | 0/1 (0%) | 1/1 (100%) |
Grade 4 | Fistula and hemorrhagic cystitis (n.= 4); permanent damage |
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Lee, S.J.; Kim, M.; Kwak, Y.-K.; Kang, H.J. The Clinical Course of the Late Toxicity of Definitive Radiotherapy in Cervical Cancer. Medicina 2024, 60, 1364. https://doi.org/10.3390/medicina60081364
Lee SJ, Kim M, Kwak Y-K, Kang HJ. The Clinical Course of the Late Toxicity of Definitive Radiotherapy in Cervical Cancer. Medicina. 2024; 60(8):1364. https://doi.org/10.3390/medicina60081364
Chicago/Turabian StyleLee, So Jung, Myungsoo Kim, Yoo-Kang Kwak, and Hye Jin Kang. 2024. "The Clinical Course of the Late Toxicity of Definitive Radiotherapy in Cervical Cancer" Medicina 60, no. 8: 1364. https://doi.org/10.3390/medicina60081364