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Urban R, Wong J, Lim P, Zhang S, Spadinger I, Olson R, Bachand F, Ho C, Tinker AV, Gondara L, Hamilton SN. Cervical cancer patient reported gastrointestinal outcomes: intensity/volumetric modulated vs. 3D conformal radiation therapy. J Gynecol Oncol 2022; 33:e70. [PMID: 35882607 PMCID: PMC9428301 DOI: 10.3802/jgo.2022.33.e70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate gastrointestinal (GI) patient reported outcomes (PROs) in cervical cancer patients treated with definitive radiotherapy (RT), comparing 3D conformal RT (3DCRT) vs. intensity modulated/volumetric modulated arc therapy (IMRT/VMAT). METHODS An analysis of patients treated with definitive RT between 2015-2018 was performed. GI PROs were prospectively collected at baseline, during RT (acute), ≤12 weeks after RT (subacute), and >12 weeks after RT (late). GI PROs evaluated three symptom domains: bowel problems (BPs), bowel bother (BB), and abdominal problems (APs). Multiple linear regression analysis was performed to investigate associations between mean changes of symptom scores with clinical and dosimetric variables. RESULTS The cohort included 167 patients. A total of 100 (60%) patients were treated with IMRT/VMAT and 67 (40%) with 3DCRT. In the subacute phase, the mean change of symptom scores from baseline in 3DCRT vs. IMRT/VMAT were +0.9 vs. -1.15 (p=0.004) for BP, +2.18 vs. -0.10 (p=0.019) for BB, and +1.41 vs. -0.38 (p=0.021) for AP. Likewise, in the late phase, mean changes were +0.72 vs. -0.82 (p=0.014) for BP, +1.98 vs. -0.03 (p=0.008) for BB, and +1.29 vs. -0.31 (p<0.001) for AP. On multiple linear regression, use of 3DCRT vs. IMRT/VMAT was associated with greater mean changes in subacute BP (p=0.023) and late phase AP (p=0.019). A higher small bowel V50Gy was associated increased symptom scores in late AP (p=0.012). CONCLUSION 3DCRT was associated with significantly greater worsening of GI PRO symptom scores in the subacute and late phase. These data support the ongoing use of IMRT/VMAT in routine practice.
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Affiliation(s)
- Ryan Urban
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Justin Wong
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Peter Lim
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Susan Zhang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Medical Physics, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Ingrid Spadinger
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Medical Physics, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Robert Olson
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Prince George, Prince George, BC, Canada
| | - Francois Bachand
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Kelowna, Kelowna, BC, Canada
| | - Clement Ho
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Surrey, Surrey, BC, Canada
| | - Anna V Tinker
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Lovedeep Gondara
- Department of Population Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada
| | - Sarah Nicole Hamilton
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.
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