News | Intensity Modulated Radiation Therapy (IMRT) | September 29, 2016

Cervical and Endometrial Cancer Patients Report Fewer Side Effects with IMRT

Results of international, multi-center trial focus on patient-reported outcomes for bowel and urinary side effects and health-related quality of life, which improved compared to conventional radiation therapy

cervical and endometrial cancer, IMRT, intensity modulated radiation therapy, side effects, ASTRO 2016 study

September 29, 2016 — Patients with cervical and endometrial cancer have fewer gastrointestinal and genitourinary side effects and experience better quality of life when treated with intensity-modulated radiation therapy (IMRT) than with conventional radiation therapy (RT), according to new research. Women receiving IMRT reported significantly fewer bowel and bladder problems than those receiving conventional radiation treatment.

The research was presented at the 58th Annual Meeting of the American Society for Radiation Oncology (ASTRO), Sept. 25-28 in Boston.

Many women diagnosed with cervical or endometrial cancer receive RT following surgery to remove their tumors, but questions remain as to which form of pelvic RT delivery can most effectively eliminate the tumor while minimizing the impact of radiation on surrounding healthy tissue. This multi- center, international study assessed this impact by evaluating patient-reported acute toxicities in the gastrointestinal (GI) and genitourinary (GU) systems following IMRT, an advanced form of external beam RT that delivers precise radiation doses highly tailored to patients’ individual tumors, versus standard four-field RT.

“The way that radiation therapy is performed has a major impact on the risk of side effects from treatment,” said Ann H. Klopp, M.D., Ph.D., lead author of the study and an associate professor in the department of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston. “We know that IMRT reduces the amount of normal tissue irradiated, so we suspected that it would have fewer side effects. This was one of the first studies, however, to rigorously ask this question using patient questionnaires to ensure that the lower doses resulted in meaningful differences in patients’ experiences during treatment.”

A total of 278 patients with cervical or endometrial cancer who received pelvic RT post-operatively at cancer centers in the United States, Canada, Japan and Korea were evaluated to determine if pelvic IMRT for cervical and endometrial cancer resulted in fewer patient-reported GI and GU side effects and improved patients’ QOL. Patients were stratified based upon RT dose (45 Gy or 50.4 Gy), use of chemotherapy (no chemotherapy or five cycles of weekly cisplatin at 40 mg/m2) and disease site. The patients were then randomly assigned to receive standard RT or IMRT.

Acute GI and GU toxicities and QOL were measured via multiple patient questionnaires. Instruments included the Expanded Prostate Cancer Index Composite (EPIC) to measure bowel and urinary toxicities, the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) to assess GI- and GU-related adverse events (e.g., diarrhea), and the Functional Assessment of Cancer Therapy – General with cervix subscale (FACT-Cx) to track health- related QOL. Researchers compared changes in average scores on these instruments from baseline to five weeks following RT start using two-way t-tests.

Patients in the IMRT arm experienced significantly fewer bowel-related toxicities than patients who received standard RT did, as indicated by smaller average declines in their EPIC bowel domain scores (- 18.6 vs. -23.6, p = 0.048). Analysis of sub-scales within the EPIC determined that IMRT patients experienced less severe declines in bowel function but not bowel bother.

IMRT patients also experienced fewer high-level adverse events following treatment, including less diarrhea (frequency: 33.7 vs. 51.9 percent, p = 0.01) and fecal incontinence (frequency: 1.1 vs. 9.3, p = 0.01). Moreover, roughly one in five women in the standard RT group (20.4 percent) reported taking four or more anti-diarrheal medications daily, compared to 7.8 percent of women in the IMRT group (p = 0.04).

Urinary side effects at five weeks from treatment start were less prevalent among patients who received IMRT, as indicated by significantly smaller declines in average EPIC urinary domain scores for the IMRT arm (-5.6 vs. -10.4, p = 0.03). Furthermore, IMRT regime negatively impacted patients’ QOL less substantially than the conventional RT regime did. FACT-Cx trial outcome index scores demonstrated less decline in health-related QOL following IMRT compared to standard RT (-8.8 vs. -12.8, p = 0.06). Patients treated with IMRT had less change in physical well-being (-4.2 vs. -6.1, p = 0.03) and addition concerns (-2.7 vs. -4.9, p = 0.01).

“Many radiation oncologists already use IMRT for women undergoing pelvic radiation, but this research provides data that using IMRT, which is a more resource-intensive treatment, makes a real difference to patients receiving radiation therapy to the pelvic area,” said Klopp. “When performed by an experienced radiation oncology team, IMRT reduces the risk of short-term bowel and bladder side effects for patients with endometrial and cervical cancer.”

For more information: www.astro.org

Related Content

Accuray Incorporated announced that Mercy Hospital St. Louis continues to demonstrate its commitment to improving patient outcomes with the installation of the first CyberKnife M6 System in Missouri at their state-of-the-art David C. Pratt Cancer Center
News | Stereotactic Body Radiation Therapy (SBRT) | February 27, 2020
February 27, 2020 — Accuray Incorporated announced that Mercy
Christopher Comstock, M.D., ECOG-ACRIN Cancer Research Group study published in JAMA builds evidence for use of abbreviated MRI in women with dense breasts

Christopher Comstock, M.D., (Memorial Sloan Kettering Cancer Center) is the lead author of a paper in JAMA that reports that abbreviated breast MRI detected significantly more (almost 2 and a half times as many) breast cancers than digital breast tomosynthesis (3-D mammography) in average-risk women with dense breasts. Photo courtesy of Memorial Sloan Kettering Cancer Center

News | Breast Imaging | February 26, 2020
February 26, 2020 — According to a study
An example of the MRI scans showing long-term and short-term survival indications. #MRI

An example of the MRI scans showing long-term and short-term survival indications. Image courtesy of Case Western Reserve University

News | Magnetic Resonance Imaging (MRI) | February 21, 2020
February 21, 2020 — ...
A cutting-edge magnet resonance imaging (MRI) technique to detect iron deposits in different brain regions can track declines in thinking, memory and movement in people with Parkinson's disease #Parkinsons #MRI

Summary steps of the processing pipeline for QSM reconstruction (phase pre-processing and map estimation) and whole brain/regional analysis. ANTs, advanced normalisation tools; MP-RAGE, magnetisation-prepared, 3D, rapid, gradient-echo; MSDI, multi-scale dipole inversion; QSM, quantitative susceptibility mapping; ROI, region of interest; SWI, susceptibility weighted imaging.

News | Magnetic Resonance Imaging (MRI) | February 21, 2020
February 21, 2020 — A cutting-edge...
Arizona State University researchers (in collaboration with Banner MD Anderson Cancer Center) have discovered a biocompatible cost-effective hydrogel that can be used to monitor therapeutic doses of ionizing radiation by becoming more pink with increasing radiation exposure

Arizona State University researchers (in collaboration with Banner MD Anderson Cancer Center) have discovered a biocompatible cost-effective hydrogel that can be used to monitor therapeutic doses of ionizing radiation by becoming more pink with increasing radiation exposure. This picture shows a circle of hydrogel that was irradiated on the left half, which is slightly pink; whereas the right half of the gel is not irradiated and remains colorless.

News | Radiation Therapy | February 18, 2020
February 18, 2020 — More than half of all cancer patients undergo radiation therapy and the dose is critical.
Nuclear imaging equipment growth in 2020
News | Nuclear Imaging | February 14, 2020
February 14, 2020 — The nuclear imaging equipment
Varian announced it has received FDA 510(k) clearance for its Ethos therapy, an Adaptive Intelligence solution. Ethos therapy is an artificial intelligence (AI)-driven holistic solution that provides an opportunity to transform cancer care.
News | Image Guided Radiation Therapy (IGRT) | February 11, 2020
February 11, 2020 — Varian announced it has received FDA 510(k) c
The radiation therapy market is projected to grow in through 2026

Image courtesy of Accuray

News | Proton Therapy | February 10, 2020
February 10, 2020 — Amid technological advancement, and notable research and development activities, the global ...
Accuray TomoTherapy total body irradiation
News | Radiation Therapy | February 07, 2020
February 7, 2020 — Accuray Incorporated announced that two new studies demonstrate the benefits of the ...