Bone marrow sparing intensity modulated radiotherapy concurrent with chemotherapy for treatment of cervical malignancy

Abstract

Author(s): Al Shimaa Maged Mohamed Abd El Naby El-Tawab*, Ashraf Fathy Barakat, Fatma Zakaria Hussien, Amr Abd El Aziz Ghanam and Mohamed Mahmoud Abdel Hakim

Background: This phase 2 prospective randomized double-arm study carried out at Clinical Oncology Department Tanta University, Radiotherapy Department, NCI, Cairo University and Gharbia cancer society through the period from May 2018 to December 2019 and enrolled 60 patients with cervical carcinoma.

Aim: The main objective of this study was evaluation of bone marrow sparing IMRT versus standard IMRT as a planning limitation in cervical cancer therapy receiving concurrent chemo radiotherapy for evaluation of the response of treatment,toxicity profile and quality of life of both radiotherapy treatment modalities.

Patients and Methods: Sixty Cervical cancer Patients were placed into two groups: those who received standard IMRT (group A) and bone marrow sparing IMRT (group B) with constraint of Bone marrow according to RTOG 0418 (V20 <75%, V10 <90%, V40 <37%, mean <34.2Gy), the toxicity was graded according to RTOG/EORTC and CTCAE and Quality of life (EORTC QOL C30- CX-24 ) was recorded at initial, 1, 4, and 12 months after treatment.

Results: There was statistically significant difference in favor of IMRT bone marrow sparing plans regarding a lower dose to organs at risk, total pelvic bone and bowel.

Grade 3 neutropenia reported during radiotherapy was significantly difference (p=0.004) as 25% of patients in group A against 0% in group B.

The response of sixty cervical cancer patients was 70% had no signs of illness after a median of 24 months of follow-up (range 13 months – 36 months),15% still had local residual tumour and 15% had distant metastases.

QOL were significantly difference in group B than group A for physical function, fatigue, nausea& vomiting, diarrhea, and symptom experience domain.

Conclusion: Bone marrow sparing improves quality of life and adherence of patients to treatment with reduced adverse events.

Share this article