Acute toxicities of three-dimensional conformal radiotherapy in the treatment of gynecological cancer, and retrospective dosimetric comparison of three dimensional conformal radiotherapy and invers intensity-modulated radiotherapy

Abstract

Aim: The study was designed to compare the critical organ and bone marrow doses with three-dimensional conformal radiotherapy plans and intensity-modulated radiotherapy re-treatment plans and to evaluate acute toxicities of three-dimensional conformal radiotherapy for gynecological cancer.

Methods: Twenty-eight patients who underwent conformal radiotherapy (3D-CRT) were evaluated retrospectively and were re- planned according to IMRT technique. The critical organ and bone marrow doses of patients were compared dosimetrically. Evaluation of early side effects was performed using RTOG toxicity scale and European Organization for Research and Treatment of Cancer (EORTC) QLQ30 side effect evaluation questionnaire.

Results: The assessment of early toxicity revealed Grade 1 lower gastrointestinal (GIS) toxicity in 16 (57.1%) patients, grade 1 upper GIS toxicity in 9 (32.1%) patients, grade 1 hematological toxicity in one (3.6%) patients, grade 1 genitourinary toxicity in 15 (53.6%), grade 1 skin toxicity in (50%) 14 patients . One patient (3.6%) had grade 2 upper GIS toxicity, 11 patients (39.3%) had grade 2-3 hematological toxicity. Bone marrow V20 (p<0.001), V95 (%) of bone marrow (p<0.001), urinary bladder V40 (p<0.001), urinary bladder mean dose (p<0.001), rectum V40 (p<0.001), rectum mean dose (p<0.001), small bowel V40 (p<0.001) were received lower doses in the IMRT planning arm than the conformal planning arm.

Conclusion: 3D-CRT is a safe treatment with acceptable low toxicity levels in gynecological cancer patients, and it does not adversely affect quality of life. IMRT reduce dose to the bone marrow and the normal tissues as compared to 3D-CRT.

Keywords

• Gynecological cancer,Acute toxicities,Conformal radiotherapy,Quality of life,Intensity modulated radiotherapy

Jinekolojik kanserlerde retrospektif üç boyutlu konformal radyoterapi ve yoğunluk ayarlı radyoterapinin dozimetrik karşılaştırılması ve üç boyutlu konformal radyoterapinin akut yan etkileri

Öz

Amaç: Jinekolojik kanserlerde retrospektif üç boyutlu konformal radyoterapi tedavisine ait akut yan etkileri değerlendirmek ve yoğunluk ayarlı radyoterapinin ve üç boyutlu konformal radyoterapinin kemik iliği ve riskli organların dozimetrik olarak karşılaştırmak amaçlanmıştır. 

Yöntemler: Üç boyutlu konformal radyoterapi ile tedavisi tamamlanmış 28 hasta retrospektif olarak değerlendirildi ve hastalar IMRT tekniğine göre yeniden planlandı. Olguların kemik iliği ve kritik organ dozları dozimetrik olarak karşılaştırıldı. Olgularda yan etki değerlendirmesi RTOG toksisite skalası ve yaşam kalitesi Avrupa Kanser Araştırma ve Tedavi Merkezi (EORTC) QLQ30 anketi uygulanarak değerlendirildi. 

Bulgular: Akut yan etkiler değerlendirildiğinde grad 1 alt gastrointestinal (GIS) yan etki 16 (% 57,1) olguda, grad 1 üst GIS yan etki 9 (%32,1) olguda, grad 1 hematolojik yan etki 1 (% 3,6) olguda, grad 1 cilt yan etki 14 (% 50) olguda görüldü. Grad 2 üst GIS yan etki 1 (% 3,6) olguda, grad 2-3 hematolojik yan etki 11 (% 39,3) olguda görüldü. Kemik iliği V20 (p<0,001), kemik iliği V95 (%) (p<0,001)  mesane V40 (p<0,001), mesane ortalama doz (p<0,001), rektum V40 (p<0,001), rektum ortalama doz (p<0,001), ince barsak V40 (p<0,001) yoğunluk ayarlı radyoterapi ile konformal radyoterapiden daha düşük doz aldı.   

Sonuç: IMRT reduce dose to the bone marrow and the normal tissues as compared to 3D-CRT. Üç boyutlu radyoterapi jinekolojik kanserlerde düşük yan etki seviyesiyle kabul edilebilir güvenilir bir tedavidir ve yaşam kalitesini olumsuz etkilemez. Yoğunluk ayarlı radyoterapi kemik iliği ve riskli organ dozlarını konformal radyoterapiye göre daha iyi kısıtlar.

Anahtar Kelimeler

• Jinekolojik kanser,Akut yan etkiler,Yaşam kalitesi,Konformal radyoterapi,Yoğunluk ayarlı radyoterapi

Kaynakça

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