Introduction: The global burden of cancer remains substantial, with millions of new cases and deaths annually. Cervical cancer ranks prominently among these statistics. In India alone, cervical cancer accounts for a significant number of cases and is a considerable public health concern. The established therapeutic approach for locally advanced cervical cancer involves a combination of external beam radiotherapy (EBRT) with concurrent chemotherapy followed by brachytherapy. The widely adopted Three-Dimensional Conformal Radiation Therapy (3DCRT) for EBRT, while effective, has been associated with noteworthy side effects when used concomitantly with chemotherapy.

Methods: This study focuses on a cohort of cervical cancer patients treated at the Department of Radiation, State Cancer Institute, Indira Gandhi Institute of Medical Science, Patna, between January 2022 and July 2022. The research examines two distinct treatment techniques: 3DCRT (FIF technique) utilized in 50 cases, and Intensity-Modulated Radiotherapy (IMRT) employed in another 50 cases. All patients received treatment with curative intent, combining EBRT with chemotherapy, and were selected based on Karnofsky scores above 70. A comprehensive review of clinical records was conducted.

Results: The patient cohort primarily consisted of individuals over 50 years of age, predominantly diagnosed with squamous cell carcinoma. The staging distribution, according to the International Federation of Gynecology and Obstetrics (FIGO) classification, indicated a prevalence of stage IIIA and IIIB cases. Hemoglobin levels ranged from 7.5 to 9.5 g%, and a subset of patients (17%) necessitated blood transfusions during treatment.

Conclusion: Comparative analysis between 3DCRT and IMRT techniques revealed that Intensity-Modulated Radiotherapy offers the advantage of precise dose distribution to tumor sites while minimizing exposure to critical organs at risk (OAR), such as the bladder, rectum, bowel, and bones. This approach holds promise in reducing the incidence of side effects associated with traditional treatment methods.

Keywords: Cervical Cancer; External Beam Radiotherapy (EBRT); Three-dimensional conformal Radiation Therapy (3DCRT); Intensity modulated Radiotherapy

References

1. Globocan (2020).
2. International Agency for research on cancer, GLOBOCA 2018 database (2018).
3. Lyon, France: International agency for research on cancer (2018).
4. National Centre for Disease Informatics and Research. Three-year Report of population-based cancer registries 2012-2014. Incidence, Distribution, Trends in Incidence rates and Projections of Burden of cancer (Report of 27 PBCRs in India). National Centre for disease Informatics and Research, National Cancer Registry Programme, Indian Council of Medical Research (2016).
5. Nandakumar A., et al. “The $ magnitude of cancer cervix in India”. Indian Journal of Medical Research 130 (2009): 219-221.
6. Schiffman M., et al. “Human papillomavirus and cervical cancer”. Lancet 370 (2007): 890-907.
7. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. “Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials”. Journal of Clinical Oncology 26 (2008): 5802-12.
8. Whitton A., et al. “Organisational standards for the delivery of intensity-modulated radiation therapy in Ontario”. Clinical Oncology the Royal College of Radiologists 21 (2009): 192-203.
9. Nutting CM., et al. “Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer”. International Journal of Radiation Oncology, Biology, Physics 48 (2000): 649-56.
10. Purdy JA. “Intensity-modulated radiotherapy: current status and issues of interest”. International Journal of Radiation Oncology, Biology, Physics 51 (2001): 880-914.
11. Portelance L., et al. “Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation”. International Journal of Radiation Oncology, Biology, Physics 51 (2001): 261-266.
12. Naik A., et al. “Dosimetric comparison between intensity modulated radiotherapy and three dimensional conformal radiotherapy planning in patients with locally advanced cervical carcinoma”. International Journal of Radiation Research 14 (2016): 189-196.
13. Isohashi F., et al. “Intensity-modulated radiation therapy versus three-dimensional conformal radiation therapy with concurrent nedaplatin-based chemotherapy after radical hysterectomy for uterine cervical cancer: comparison of outcomes, complications, and dose-volume histogram parameters”. Radiation Oncology 10 (2015): 180.
14. Gandhi AK., et al. “Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study”. International Journal of Radiation Oncology, Biology, Physics 87 (2013): 542-548.
15. Avinash HU., et al. “A prospective dosimetric and clinical comparison of acute hematological toxicities in three-dimensional conformal radiation therapy and intensity modulated radiation therapy with concurrent chemotherapy in carcinoma cervix”. Journal of Cancer Research and Therapeutics 11 (2015): 83-87.
16. Lukovic J., et al. “Intensity-modulated radiation therapy versus 3D conformal radiotherapy for postoperative gynecologic cancer: are they covering the same planning target volume?” Cureus 8 (2016): e467.
17. Yang B., et al. “Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis”. Radiation Oncology 7 (2017): 197.
18. Yu C., et al. “A comparative study of intensity-modulated radiotherapy and standard radiation field with concurrent chemotherapy for local advanced cervical cancer”. European Journal of Gynaecological Oncology 36 (2015): 278-282.
19. Lin Y., et al. “Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis”. Radiation Oncology 13 (2018): 177.
20. Dracham CB., et al. “Toxicity and clinical outcomes with definitive three-dimensional conformal radiotherapy (3DCRT) and concurrent cisplatin chemotherapy in locally advanced cervical carcinoma”. Japanese Journal of Clinical Oncology 49 (2019): 146-152.
21. Whitton A., et al. “Organisational standards for the delivery of intensity- modulated radiation therapy in Ontario”. Clinical Oncology the Royal College of Radiologists 21 (2009): 192-203.
22. Georg P., et al. “Factors influencing bowel sparing in intensity modulated whole pelvic radiotherapy for gynaecological malignancies”. Radiotherapy Oncology 80 (2006): 19-26.
23. Heron DE., et al. “Conventional 3D conformal versus intensity- modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosimetric study of dose-volume histograms small star, filled”. Gynecologic Oncology 91 (2003): 39-45.
24. Ahmed RS., et al. “IMRT dose escalation for positive para-aortic lymph nodes in patients with locally advanced cervical cancer while reducing dose to bone marrow and other organs at risk”. International Journal of Radiation Oncology, Biology, Physics 60 (2004): 505-512.
25. Mell LK., et al. “Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer”. International Journal of Radiation Oncology, Biology, Physics 71 (2008): 1504-1510.
26. Igdem , et al. “Dosimetric comparison of intensity modulated pelvic radiotherapy with 3D conformal radiotherapy in patients with gynecologic malignancies”. European Journal of Gynaecological Oncology 30 (2009): 547-551.
27. Chen MF., et al. “Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity- modulated pelvic radiotherapy: comparison with conventional radiotherapy”. International Journal of Radiation Oncology, Biology, Physics 67 (2007): 1438-1444.
28. Roeske , et al. “Intensity- modulated whole pelvic radiation therapy in patients with gynecologic malignancies”. International Journal of Radiation Oncology, Biology, Physics 48 (2000): 1613-1621.
29. Lujan AE., et al. “Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy”. International Journal of Radiation Oncology, Biology, Physics 57 (2003): 516-521.
30. Mundt AJ., et al. “Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy”. International Journal of Radiation Oncology, Biology, Physics 56 (2003): 1354-1360.
31. Brixey CJ., et al. “Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies”. International Journal of Radiation Oncology, Biology, Physics 54 (2002): 1388-1396.
32. Mell LK., et al. “Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy”. International Journal of Radiation Oncology, Biology, Physics 66 (2006): 1356-1365.
33. Salama JK., et al. “Preliminary outcome and toxicity report of extended-field, intensity-modulated radiation therapy for gynecologic malignancies”. International Journal of Radiation Oncology, Biology, Physics 65 (2006): 1170-1176.
34. George D., et al. “Assessment of improved organ at risk sparing for advanced cervix carcinoma ulilizing precision radiotherapy techniques”. Strahlentherapie und Onkologie 184 (2008): 586-591.
35. Van de Bunt L., et al. “Conventional, conformal, andintensity-modulated radiation therapy treatment planning ofexternal beam radiotherapy for cervical cancer: the impact of tumor regression”. International Journal of Radiation Oncology, Biology, Physics 64 (2006): 189-196.
36. Sharma N., et al. “A prospective Randomized Study of Intensity Modulated Radiation Therapy Versus Three Dimensional conformal Radation Therapy with Concurrent Chemotherapy in Locally Advanced Carcinoma Cervix”. Cureus1 (2022): e21000.
37. Isohashi F., et al. “Intensity modulated radiation therapy versus three-dimensional conformal radiation therapy with concurrent nedaplatin based chemotherapy after radical hysterectomy for uterine cervical cancer: comparison of outcome, complications, and dose volume histogram parameters”. Radiation Oncology 10 (2015): 180.
38. Gandhi AK., et al. “Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study”. International Journal of Radiation Oncology, Biology, Physics 87 (2013): 542-548.
39. Yang B., et al. “Dosimetric comparison of intensity modulated radiotherapy and three-dimensional conformal radiotherapy in patients with gynecologic malignancies: a systematic review and meta-analysis”. Radiation Oncology 7 (2012):

Citation

Citation: Seema Devi., et al. “Comparative Analysis of Treatment Outcomes and Toxicity in Cervical Cancer Patients: Three-Dimensional Conformal Radiotherapy vs. Intensity Modulated Radiotherapy”.Acta Scientific Cancer Biology 8.3 (2024): 10-16.

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Copyright: © 2024 Seema Devi., et al. “Study of p16INK4a Immunostaining as Specific Biomarker in the diagnosis of Cervical Intraepithelial Neoplasia and This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.