Frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer. Study Design: A case series. Place and Duration of Study: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012. Methodology: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapy's side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at the end of treatment. The data was analyzed by using SPSS version 16. Results: Out of the 99 enrolled patients, 58 (58.6%) had uterine and 41 (41.4%) had cervical cancer. Mean age was 54.54 ±10.29 years. Thirty-five (35.4%) patients received chemotherapy with RT. Mean RT dose was 60.72 ±7.15 Gy. The most common gastrointestinal adverse effect was diarrhea in 64 (64.6%) followed by proctitis in 55 (55.5%), nausea in 33 (33.3%) and vomiting in 16 (16.2%) patients. Grade (G) 1 was the most frequently observed severity. The most common hematological toxicity was anemia in 37.8% (n=31/82) (G1=18 (21.9%), G2=11 (13.4%), G3=2 (2.4%) followed by thrombocytopenia in 22.8% (21/92) (G1=16 (17.3%), G2=2 (2.1%), G3=3 (3.2%) and neutropenia in 21 (21.2%) (G1=12 (12.1%), G2=5 (5%), G3=3 (3%), G4=1 (1%). Urinary toxicity was observed in 49 (49.5%) patients. On stratification, chemotherapy and higher RT dose were strong predictor of increased hematological and upper gastrointestinal toxicity (p < 0.05) and age > 60 years for diarrhea (p < 0.05). Conclusion: The frequency and severity of acute toxicity of pelvic radiotherapy in women with gynecologic cancers was found intermediate to high.