title: Radiotherapy dose escalation with concurrent chemotherapy in locally advanced cervix cancer is feasible.
abstract: BACKGROUND
  To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity.
  
  
  METHODS
  Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment.
  
  
  RESULTS
  Mean age was 46 (30-63) and 47 years (33-67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I-II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I-III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity.
  
  
  CONCLUSIONS
  VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT "Box". We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT.
authors.affiliation: Department of Radiation Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Centre, MBC 64, PO Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia.|Department of Clinical Oncology and Nuclear Medicine, Zagazig Faculty of Medicine, Zagazig, Egypt.
authors.forename: M W
authors.initials: MW
authors.lastname: Hegazy
authors.affiliation: Department of Radiation Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Centre, MBC 64, PO Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia. oncologist@doctors.org.uk.
authors.forename: R I
authors.identifier: http://orcid.org/0000-0002-7298-6150
authors.initials: RI
authors.lastname: Mahmood
authors.affiliation: Department of Gynaecologic Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: I A
authors.initials: IA
authors.lastname: Al-Badawi
authors.affiliation: Department of Biomedical Physics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: B
authors.initials: B
authors.lastname: Moftah
authors.affiliation: Department of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: AlHusaini
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*
keywords: Cervix cancer; Radiotherapy dose escalation; Treatment toxicity; VMAT