Table 2.
Toxicity and survival rates for cervical cancer patients for retrospective and prospective study designs
| [ref] | Study design | Period of study | N | Prescription | RT technique | Median follow-up | Outcomes- Toxicity | Outcomes- Survival |
|---|---|---|---|---|---|---|---|---|
| 58 | Retrospective | 01/2013–12/2014 | 18 | PTV 50.4 Gy in 28 F | VMAT:2 6 MV coplanar mono-isocentric arcs | 30.5 months (IQR: 13–36.25 months). |
Acute haematologic toxicity Haemoglobin G0: 23.5% G1: 17.7% G2: 58.8% TLC G0: 47% G1: 35.5% G2: 17.7% Platelets G0: 88.2% G1: 5.9% G2: 5.9% |
OS 72.2% (95%CI: 62.1–80.5%) DFS 2 year DFS was 63.3% (95% CI: 52.8–72.4%) |
| 59 | Retrospective | 12/2010–05/2017 IMRT: 12/2010–09/2012 VMAT: 05/2013–05/2017 |
398 | Phase I: whole pelvis VMAT or IMRT 45/25F or 50 Gy/28F 25–28 Phase II: Lymph node boost up to 60–70 Gy |
IMRT (n = 67) VMAT (n = 331) |
IMRT 35.07 (range, 4.80–90.37) months VMAT 25.47 (range, 0.93–58.93) months |
VMAT group, the incidence of Grade 3 and four acute anaemia/erythropenia were 3.6 and 0.9%. acute Grade 3 and 4 leukopenia were 8.5 and 0.6% |
IMRT
3 year OS: 76.2% 3 year DFS: 76.4% 3 year LC: 83.1% 3 year DMFS: 86.1% VMAT 3 year OS 80.5% 3 year DFS 65.4% 3 year LC 88.7% 3 year DMFS 78.1%. CCRT vs non-CCRT 3 year OS in the CCRT 84.8vs 65.4% non-CCRT (p = 0.005) |
| 57 | Multicentre randomised control trial | 11/2012–08/2015 | 278 | Phase I 45 Gy/25F or 50.4 Gy/28F |
IMRT- (inverse planning approaches: IMRT, VMAT, and tomotherapy) (n = 129) 3DCRT (Four field box technique) (n = 149) |
Acute effects assessed during treatment |
Physician Reported Outcomes
No Grade 5 AE Grade 3 and 4 AEs: 16.4%(IMRT);11.0% (3DCRT) (p = 0.28) GI AEs Acute Grade 2 GI AEs (IMRT- 26.2% v 3DCRT- 22.1%; p = 0.43). Patient reported outcomes Mean decrease- EPIC urinary summary score (wk3 and 5 compared with baseline) 3 week results IMRT (26.0 [SD, 14.5] v 22.5 [SD, 11.3]; p = 0.04 5 week results IMRT −210.4 [SD, 17.5] v 3DCRT 25.6 [SD, 15.3]; p = 0.03 EPIC urinary score at 5 weeks favoured the IMRT arm (estimate, 24.59; SD, 2.19; p = 0.04) |
Not analyzed |
| 60 | Prospective study | 09/2011–04/2015 | 30 | Macroscopic disease 66 Gy/30F; Pelvis 54 Gy/30F |
SIB-VMAT technique two 3600_ arcs with 6 MV | 32 months (range: 8–50 months) |
Acute GI toxicity
G0- 30%; G1-23%; G2-43% Late GI toxicity G0-70%; G1- 30% Acute Urinary G0-23%; G1-40%; G2-37% Late urinary G0-90%; G1-10% Acute Vaginal G0-7%; G1-63%; G2-23% Late vaginal toxicity G0-77%; G1-23% Acute Rectal toxicity G0-47%; G1-30%; G2-23% Late Rectal toxicity G0-73%; G1-20% Acute Hematologic G0-70%; G1-30% Late Hematologic G0-87%; G1-13% |
3 year OS- 93% 3 year LC 80%, Clinical outcomes by stage (II vs III) 3 year OS Stage II- 100% 3 year OS Stage III- 85% 3 year LC (Stg II) 91% 3 year LC (Stg III) 67% |
| 61 | Retrospective | 01/2007–12/2016 | 123 | 45 Gy/25F or 50.4 Gy/28F | 3DCRT IMRT VMAT Tomotherapy |
32.2 months | Not assessed |
Survival rates < 70 years vs >70 years
3 year OS 63.9vs 50.6% 5 year OS 60.4vs 39.1 % 3 year CSS 68.2vs 70.9% 5 year CSS 78.2vs 82.1 % 3 year LRRFS 82.8vs 82.1% 5 year LRRFS 78.2vs 82.1% 3 year LRFS 85.3vs 82.1% 5 year LRFS 82.6vs 82.1% |
Terms: 3DCRT, 3D conformal radiotherapy; AE, adverse events; CSS, cancer-specific survival; DFS, disease free survival; DMFS, distant metastasis-free survival; EPIC, expanded prostate cancer index composite; IMRT, intensity modulated radiation therapy; LRRFS, locoregional recurrence-free survival; OS, overall survival; PRO-CTCAE, the Patient-Reported Outcomes–Common Terminology Criteria for Adverse Events; TLC, total leukocyte count; VMAT, volumetric modulated arc therapy