PURPOSE: To test the hypothesis that intensity modulated radiation therapy (IMRT) reduces acute hematologic and gastrointestinal (GI) toxicity for patients with locoregionally advanced cervical cancer. METHODS AND MATERIALS: We enrolled patients with stage IB-IVA cervical carcinoma in a single-arm phase II trial involving 8 centers internationally. All patients received weekly cisplatin concurrently with once-daily IMRT, followed by intracavitary brachytherapy, as indicated. The primary endpoint was the occurrence of either acute grade ≥3 neutropenia or clinically significant GI toxicity within 30 days of completing chemoradiation therapy. A preplanned subgroup analysis tested the hypothesis that positron emission tomography-based image-guided IMRT (IG-IMRT) would lower the risk of acute neutropenia. We also longitudinally assessed patients' changes in quality of life. RESULTS: From October 2011 to April 2015, 83 patients met the eligibility criteria and initiated protocol therapy. The median follow-up was 26.0 months. The incidence of any primary event was 26.5% (95% confidence interval [CI] 18.2%-36.9%), significantly lower than the 40% incidence hypothesized a priori from historical data (P=.012). The incidence of grade ≥3 neutropenia and clinically significant GI toxicity was 19.3% (95% CI 12.2%-29.0%) and 12.0% (95% CI 6.7%-20.8%), respectively. Compared with patients treated without IG-IMRT (n=48), those treated with IG-IMRT (n=35) had a significantly lower incidence of grade ≥3 neutropenia (8.6% vs 27.1%; 2-sided χ2P=.035) and nonsignificantly lower incidence of grade ≥3 leukopenia (25.7% vs 41.7%; P=.13) and any grade ≥3 hematologic toxicity (31.4% vs 43.8%; P=.25). CONCLUSIONS: IMRT reduces acute hematologic and GI toxicity compared with standard treatment, with promising therapeutic outcomes. Positron emission tomography IG-IMRT reduces the incidence of acute neutropenia.

Chulalongkorn Hospital Bangkok Thailand

Department of Oncology and Radiotherapy University Hospital Hradec Kralove Czech Republic

Department of Radiation Medicine and Applied Sciences University of California San Diego La Jolla California

Department of Radiation Oncology Washington University St Louis Missouri

Kaiser Permanente Medical Center San Diego California

Marie Sklodowska Cancer Center and Institute of Oncology Gliwice Poland

MD Anderson Cancer Center Houston Texas

Tata Memorial Centre Parel Mumbai India

University of California San Diego La Jolla California

Washington University St Louis Missouri

Xijing Hospital Xian China

Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):482-483. doi: 10.1016/j.ijrobp.2017.02.014. PubMed

Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):483-484. doi: 10.1016/j.ijrobp.2017.02.011. PubMed

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