Evaluation of toxicity after radical hysterectomy or trachelectomy and post-operative pelvic intensity-modulated radiation therapy with concurrent chemotherapy for cervical cancer

Abstract

Objective: Compared to historical standards, intensity-modulated radiation therapy minimizes radiation dose to critical structures. Here, we characterize acute/chronic complications of intensity-modulated radiation therapy with concurrent chemotherapy following radical surgery for cervical cancer.

Methods: This single-institution, retrospective study included patients who underwent radical hysterectomy/trachelectomy followed by adjuvant intensity-modulated radiation therapy and radiosensitizing chemotherapy for clinical stage IA to IIA cervical cancer (01/2007-8/2021). Treatment-related adverse events were collected and graded at baseline, 3 weeks, and 5 weeks after intensity-modulated radiation therapy, and long-term (≥6 months).

Results: We identified 91 patients who received intensity-modulated radiation therapy with concurrent chemotherapy following radical hysterectomy (n = 84, 92%) or radical trachelectomy (n = 7, 8%). Post-operatively, 66 patients (73%) met Peters criteria, 21 (23%) met Sedlis criteria, and 4 (4%) had other high-risk features. Intensity-modulated radiation therapy doses were 5040 cGy in 66% (n = 60) of patients, 4500 cGy in 30% (n = 27), and 4500 to 5040 cGy in 4% (n = 4). The most common treatment-related adverse events were fatigue (n = 77, 85%) and gastrointestinal (n = 74, 81%), followed by hematologic (n = 26, 29%) and genitourinary (n = 35, 38%). From baseline to intensity-modulated radiation therapy completion, adverse event scores significantly worsened for hematologic (p < .002), fatigue (p < .0001), gastrointestinal (p < .0001), and genitourinary toxicities (p = .003). Acute grade 3 toxicities occurred in 2% (n = 2, gastrointestinal and fatigue). There was one chronic grade 3 toxicity: lymphedema requiring lymphovenous bypass in a patient who underwent full pelvic lymphadenectomy. We observed no long-term grade 3 bowel toxicity or radiation-associated secondary malignancy.

Conclusions: Radical hysterectomy/trachelectomy followed by intensity-modulated radiation therapy with concurrent chemotherapy was associated with acceptable rates of acute/chronic toxicity. With modern post-operative intensity-modulated radiation therapy techniques, multimodal therapy for apparent stage I cervical cancer is reasonable with a very low rate of severe chronic genitourinary or gastrointestinal toxicities. Providers should continue to offer radical surgery for appropriate candidates.

Keywords: Cervical Cancer; Intensity-Modulated Radiation Therapy; Radiation Treatment; Radical Surgery.