title: Comparison of dosimetric parameters and acute toxicity of intensity-modulated and three-dimensional radiotherapy in patients with cervix carcinoma: A randomized prospective study.
abstract: OBJECTIVE
  The use of intensity-modulated radiotherapy (IMRT) to treat cervix carcinoma has increased, however prospective randomized trials are still lacking.
  
  
  OBJECTIVE
  To compare the dosimetric parameters and associated acute toxicity in patients with cervix carcinoma treated with three-dimensional (3D) conformal radiotherapy and IMRT.
  
  
  METHODS
  Forty patients were randomized in two arms each consisting of 20 patients. Patients in both arms received concurrent chemoradiation (cisplatin 40mg/m(2) weekly; 50Gy/25 fractions). Patients were treated with 3D conformal radiotherapy in one arm and with IMRT in another arm. After external beam radiotherapy, all patients received brachytherapy (21Gy/3 fractions at weekly interval). For dosimetric comparison, both kinds of the plans were done for all the patients. All patients were assessed throughout and until 90 days after completion of treatment for acute gastrointestinal, genitourinary and hematologic toxicities.
  
  
  RESULTS
  Both plans achieved adequate planning target volume coverage, while mean conformity index was found significantly better in IMRT plans (P-value=0.001). D35 (dose to 35% volume) and D50 for bladder was reduced by 14.62 and 32.57% and for rectum by 23.82 and 43.68% in IMRT. For IMRT, V45 (volume receiving 45Gy) of bowel were found significantly lesser (P-value=0.0001), non-tumour integral dose was found significantly higher (P-value=0.0240) and V20 of bone marrow was found significantly reduced (P-value=0.019) in comparison to that in 3D conformal radiotherapy. Significant reduction of grade 2 or more (20 vs 45%; P-value=0.058) and grade≥3 (5 vs 15%, P-value=0.004) acute genitourinary toxicity and grade 2 or more (20 vs 45%, P-value=0.003) and grade 3 or more (5 vs. 20%, P-value=0.004) acute gastrointestinal toxicity while no significant difference for grade 2 and 3 or more haematological toxicity was noted in patients treated with IMRT compared to 3D conformal radiotherapy.
  
  
  CONCLUSIONS
  IMRT provide a good alternative for treatment of cervix carcinoma with lower acute gastrointestinal and acute genitourinary toxicity with similar target coverage compared to 3D conformal radiotherapy.
authors.affiliation: Department of Radiotherapy, Sri Aurobindo Medical College and PG Institute, 453111 Indore, India. Electronic address: ayushnaik@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Naik
authors.affiliation: Department of Radiotherapy, Sri Aurobindo Medical College and PG Institute, 453111 Indore, India.
authors.forename: O P
authors.initials: OP
authors.lastname: Gurjar
authors.affiliation: Department of Radiotherapy, Sri Aurobindo Medical College and PG Institute, 453111 Indore, India.
authors.forename: K L
authors.initials: KL
authors.lastname: Gupta
authors.affiliation: Department of Radiotherapy, Sri Aurobindo Medical College and PG Institute, 453111 Indore, India.
authors.forename: K
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Radiotherapy, Sri Aurobindo Medical College and PG Institute, 453111 Indore, India.
authors.forename: P
authors.initials: P
authors.lastname: Nag
authors.affiliation: Department of Radiotherapy, Sri Aurobindo Medical College and PG Institute, 453111 Indore, India.
authors.forename: V
authors.initials: V
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012720:Severity of Illness Index; D014551:Urinary Tract / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D014839:Vomiting / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Carcinoma cervix; Carcinome du col de l’utérus; Intensity-modulated radiotherapy; Radiothérapie conformation tridimensionnelle; Radiothérapie conformationnelle avec modulation d’intensité; Three-dimensional conformal radiotherapy; Toxicity; Toxicité aiguë