Early Clinical Outcomes in Patients of Carcinoma Cervix Treated With Volumetric Modulated Arc Therapy

Sri Harsha Kombathula; Pandjatcharam Jagadesan; Mourougan Sinnatamby; Abhilash Menon; Durga Harika Kannikanti; Chandramouli R; John M Mathew

doi:10.7759/cureus.46798

Early Clinical Outcomes in Patients of Carcinoma Cervix Treated With Volumetric Modulated Arc Therapy

Cureus. 2023 Oct 10;15(10):e46798. doi: 10.7759/cureus.46798. eCollection 2023 Oct.

Authors

Sri Harsha Kombathula¹, Pandjatcharam Jagadesan², Mourougan Sinnatamby², Abhilash Menon³, Durga Harika Kannikanti¹, Chandramouli R⁴, John M Mathew⁵

Affiliations

¹ Clinical Oncology, East Suffolk and North Essex National Health Service (NHS) Foundation Trust, Essex, GBR.
² Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND.
³ Medical Oncology, Malabar Cancer Centre, Thalassery, IND.
⁴ Radiation Oncology, Krishna Cancer Institute, Cuddalore, IND.
⁵ Radiation Oncology, Princess Margaret Cancer Centre, Toronto, CAN.

Abstract

Objective Carcinoma cervix is one of the major cancers affecting Indian women. Concurrent chemo-radiotherapy is the standard of care in the treatment of carcinoma cervix. We aimed to study the outcomes and toxicity profile of volumetric modulated arc therapy (VMAT), an advanced modality of radiation delivery when used to treat patients with carcinoma cervix. Materials and methods Patients of carcinoma cervix belonging to FIGO (The International Federation of Gynecology and Obstetrics) stages IB2- IVA were recruited into the study. The patients were treated with VMAT to an EBRT (External Beam Radiation Therapy) dose of 50.4Gy in 28 fractions, which was followed by a brachytherapy schedule of 8Gy for each fraction to point A for three fractions. Toxicities were monitored weekly during the course of treatment and thereafter at every follow-up visit. A response assessment CECT (Contrast Enhanced Computed Tomography) scan was done three months after treatment and the response was recorded using RECIST (Response Evaluation Criteria In Solid Tumors) criteria. Results Sixty-four patients were available for analysis and most of the patients belonged to stage IIB (50.3%) followed by stage IIIB (28.5%). The complete response rate was 90.6% at three months and at a median follow-up of 12 months, the overall survival was 100% and disease-free survival was 89.1%. An analysis of clinically significant toxicities (grade 2 or worse) showed that diarrhea was the most common (20.3%) followed by proctitis (14%) and anemia (9.3%). Conclusion The results of the study established that volumetric modulated arc therapy is an acceptable modality of treatment of carcinoma cervix with an attractive toxicity profile. However, longer follow-ups will provide valuable information regarding the long-term disease control and late toxicities of the treatment.

Keywords: cancer cervix; clinical outcome; disease free survival; overall survival; radiotherapy; response assessment; toxicity; volumetric modulated arc therapy.