Chronic Toxicity With Adjuvant Intensity-Modulated vs Conventional Radiation Therapy for Cervical or Endometrial Cancer

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As reported in the Journal of Clinical Oncology by Yeung et al, updated results of the phase III NRG Oncology RTOG 1203 trial show reduced chronic toxicity with adjuvant intensity-modulated radiation therapy (IMRT) vs conventional radiotherapy (CRT) in women with cervical or endometrial cancer. No differences in efficacy outcomes were observed at 3 years.

Study Details

In the trial, 279 eligible women were randomly assigned between 2012 and 2015 to receive IMRT (n = 130) or CRT (n = 149). Radiation dose (45 Gy or 50.4 Gy) and administration of concurrent once-weekly cisplatin at 40 mg/m2 were determined by treating physicians. The primary endpoint was acute gastrointestinal toxicity at week 5 of radiotherapy measured with the bowel domain of the Expanded Prostate Cancer Index Composite (EPIC) patient-reported outcome instrument. Secondary endpoints included disease outcomes and chronic toxicity.

IMRT reduces patient-reported chronic gastrointestinal and urinary toxicity with no difference in treatment efficacy at 3 years.
— Yeung et al

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Key Findings

Median follow-up for the current analysis was 37.8 months. At 1 year after radiotherapy, more patients in the CRT group vs IMRT group had high-level diarrhea frequency (15.1% vs 5.8%, P = .042), and more had to take antidiarrheal medication at least twice a day (8.6% vs 1.2%, P = .036). No differences between groups in these measures were observed at 3 years.

At 3 years after radiotherapy, urinary function declined in the CRT group and improved in the IMRT group (P = .005 for comparison), with mean (standard deviation) changes in EPIC urinary scores of –6.0 (14.3) vs 0.5 (13.0). No significant differences between the IMRT group vs CRT group were observed in overall survival (92.4% vs 97.0%, P = .53), disease-free survival (85.5% vs 80.8%, P = .21), or locoregional failure (3.5% vs 2.2%, P = .81) at 3 years.

The investigators concluded, “IMRT reduces patient-reported chronic gastrointestinal and urinary toxicity with no difference in treatment efficacy at 3 years.”

Anamaria R. Yeung, MD, of the University of Florida Health Sciences Center, Gainesville, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit

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