Radiotherapy Dose Escalation with Concurrent Chemotherapy ImprovesOutcome in Locally Advanced Cervix Carcinoma

Background: To evaluate radiotherapy dose escalation using volumetric modulated arc therapy (VMAT) and image guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare it with conventional radiation therapy (CRT) in terms of the toxicity and clinical outcomes. Methods and Materials: Data base was reviewed for all LACC patients treated either by conventional radiation therapy or dose escalation volumetric modulated arc therapy, with concurrent weekly Cisplatin 40 mg/m2 followed by high dose rate brachytherapy. The primary and secondary endpoints were toxicity, disease-free survival and overall survival respectively. Results: Of 60 patients, 40 patients received CRT and 20 received VMAT. The median follow-up time in the CRT arm was 47 months (11-89), and 35 months (13-47) in the VMAT arm. Hemoglobin toxicity (Grade I-II) was encountered in 97.5% and 90% (p=0.03) while (Grade I-III) Leukopenia was 90% and 70% (p=0.02), respectively. There was no grade 3 or 4 gastrointestinal or genitourinary (GI or GU) toxicity. At 36 months, disease-free survival was 45% in the CRT group versus 75% in the VMAT group (p=0.03), and overall survival was 65% in the CRT group versus 85% in the VMAT group (p=0.8). Conclusion: VMAT is associated with significantly less toxicity and comparable or even better clinical outcome compared with CRT. Further studies with larger sample sizes and longer follow-up times are warranted to justify its use in routine clinical practice.