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• W2528943658 abstract "Radiation therapy (RT) is an effective palliative treatment modality for patients with locally advanced cervical carcinoma (LACC). Although no standard regime, usually short course hypo-fractionated schedules are preferred due to short expected survival period. Very often, the focus of treatment is on symptomatic relief and survival is rarely studied in such patients. Some of these patients might show good subjective and objective improvement with palliative RT and may become suitable for further curative RT with a possibility of long term survival. Our present study aims to study the survival outcome of LACC patients treated with initial short course palliative hypo-fractionated RT and subsequent curative RT. Between 2007-2012, a total of 300 LACC patients (unsuitable for curative treatment) were initially treated with short course palliative external beam RT (EBRT) with a dose of 8-30 Gy in 1-10 fractions over 1-14 days. Those who showed >50% disease regression after 4 weeks were further treated with EBRT to a minimum total dose of 50 Gy employing 2 Gy per fraction regime. Subsequent intracavitary brachytherapy (ICBT) was performed if the patients were found suitable. Disease free survival (DFS) was calculated by Kaplan-Meier survival method. Log rank test was used to find out the P value and a value of <0.05 was considered significant. Long term toxicity was assessed as per RTOG criteria. A total of 41 out of 300 patients (14%) were identified who were subsequently treated with curative RT and form the basis of present study. Median age of the patients was 47 years (range 24-78). Stage wise distribution of patients was as follows: Stage IIB, 2; IIIA, 1; IIIB, 25; IVA, 8 and IVB (solitary metastases), 5 patients. Median initial palliative EBRT dose was 20 Gy in 5 fractions over 1 week (received by 31 patients). All 41 patients received further EBRT dose equivalent to 50 Gy. Thirty patients underwent high dose rate ICBT with 7 Gy x 3 to point A. Six patients received chemotherapy prior to curative RT. Median follow up was 17 months (range 6-78 months). Nineteen patients had progressive disease, 7 had partial response and 15 had complete response to treatment. Median DFS for entire cohort was 20 months. Patients receiving ICBT had better DFS (20 months vs 7 months; P = 0.002) as compared to those who did not receive it. Other factors like age, stage, use of chemotherapy had no impact on DFS (P>0.05). Late radiation grade 3 or more rectum and bladder toxicity was seen 4 patients and 2 patients respectively. Our study has shown that about 15% LACC patients treated with initial short course hypo-fractionated palliative EBRT (20Gy/5 fractions/1 week) become eligible for curative RT. These patients show a reasonably good survival and acceptable delayed toxicity. Use of ICBT is encouraged in such patients since it has significantly improved the survival in our study." @default.
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• W2528943658 date "2016-10-01" @default.
• W2528943658 modified "2023-10-16" @default.
• W2528943658 title "Definitive Radiation Therapy of Locally Advanced Cervical Cancer Initially Treated With Palliative Hypofractionated Radiation Therapy" @default.
• W2528943658 doi "https://doi.org/10.1016/j.ijrobp.2016.06.1394" @default.
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