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• W2972450759 abstract "To determine if there is a reduction in patient-reported adverse events (AEs) or differences in disease outcome with intensity-modulated radiation therapy (IMRT) compared to conventional 4-field pelvic radiation (CRT). Patients with cervical and endometrial cancer who received postoperative pelvic radiation were randomly assigned to CRT or IMRT. The primary endpoint was change in patient-reported acute gastrointestinal (GI) AEs from baseline to 5 weeks measured by the bowel domain of Expanded Prostate Cancer Index Composite (EPIC). Change in EPIC score was calculated such that a negative change score indicated a decline in function from baseline. Secondary endpoints included a comparison of patient-reported GI AEs using PRO-CTCAE GI question set, urinary AEs using the urinary domain of EPIC, and QOL using the FACT-G. A Wilcoxon test was used for non-normal data. Log-rank tests were used for survival data and Gray’s test was used for time to failure data in the presence of competing risks (death without a failure). There were 289 patients enrolled between 2012 and 2015; 10 patients were found to be ineligible, leaving 279 eligible patients. Median follow-up for all patients was 37.8 months. There were no differences in overall survival (HR=0.76, 95% CI:0.32-1.79, p=0.53), disease-free survival (HR=1.39, 95% CI:0.82-2.35, p=0.21), or local-regional failure (2-year rate of 2.6%, 95% CI:0.7-6.9, IMRT vs. 1.4%, 95% CI: 0.3-4.6, CRT, p=0.81). There was no statistically significant difference in mean change in EPIC Bowel summary score at 1 and 3 years between arms. At 1 year post-RT there was no significant difference in the mean change in EPIC Urinary summary score between the arms. At 3 years post-RT, however, the CRT arm showed a worsening in the mean change score compared to 1-year post-RT (-1.7 at 1 year vs. -6.0 at 3 years), signifying a decline in urinary function with further follow-up, while the IMRT arm continued to show improvement from 1 year to 3 years post-RT (-1.8 to 0.5, respectively). This improvement in the IMRT arm compared with the CRT arm at 3 years is statistically significant (mean change score of 0.5, SD=13.0 vs. -6.0, SD=14.3, respectively, p=0.005). At 1 year post-RT, the CRT arm experienced more high-level diarrhea frequency measured by the PRO-CTCAE (5.8% IMRT vs. 15.1% CRT, p=0.042). There was also a significant difference at 1 year in the number of women having to take antidiarrheal medication 2 or more times a day (1.2% IMRT vs. 8.6% CRT, p=0.036). These differences in GI AEs disappeared at 3 years post-RT. We previously reported that IMRT reduces acute patient-reported GI and GU AEs compared with CRT. This analysis shows that IMRT also reduces patient-reported GI AEs and urinary AEs at 1 and 3 years of follow up, respectively. Additionally, there is no difference in treatment efficacy with IMRT, although further followup is needed." @default.
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• W2972450759 date "2019-09-01" @default.
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• W2972450759 title "IMRT Improves Late Toxicity Compared to Conventional RT: An Update on NRG Oncology-RTOG 1203" @default.
• W2972450759 doi "https://doi.org/10.1016/j.ijrobp.2019.06.480" @default.
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