Patient-reported toxicity during pelvic intensity-modulated radiation therapy

NRG oncology-RTOG 1203

Ann H. Klopp, Anamaria R. Yeung, Snehal Deshmukh, Karen M. Gil, Lari Wenzel, Shannon N. Westin, Kent Gifford, David K. Gaffney, William Small, Spencer Thompson, Desiree E. Doncals, Guilherme H.C. Cantuaria, Brian P. Yaremko, Amy Chang, Vijayananda Kundapur, Dasarahally S. Mohan, Michael L. Haas, Yong Bae Kim, Catherine Lowrie Ferguson, Stephanie L. Pugh & 2 others Lisa A. Kachnic, Deborah W. Bruner

Research output: Contribution to journalArticle

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Abstract

Purpose: NRG Oncology/RTOG 1203 was designed to compare patient-reported acute toxicity and healthrelated quality of life during treatment with standard pelvic radiation or intensity-modulated radiation therapy (IMRT) in women with cervical and endometrial cancer. Methods: Patients were randomly assigned to standard four-field radiation therapy (RT) or IMRT radiation treatment. The primary end point was change in patient-reported acute GI toxicity from baseline to the end of RT, measured with the bowel domain of the Expanded Prostate Cancer Index Composite (EPIC). Secondary end points included change in patient-reported urinary toxicity, change in GI toxicity measured with the Patient-Reported Outcome Common Terminology Criteria for Adverse Events, and quality of life measured with the Trial Outcome Index. Results: From 2012 to 2015, 289 patients were enrolled, of whom 278 were eligible. Between baseline and end of RT, the mean EPIC bowel score declined 23.6 points in the standard RT group and 18.6 points in the IMRT group (P = .048), the mean EPIC urinary score declined 10.4 points in the standard RT group and 5.6 points in the IMRT group (P = .03), and the mean Trial Outcome Index score declined 12.8 points in the standard RT group and 8.8 points in the IMRT group (P = .06). At the end of RT, 51.9% of women who received standard RT and 33.7% who received IMRT reported frequent or almost constant diarrhea (P = .01), and more patients who received standard RT were taking antidiarrheal medications four or more times daily (20.4% v 7.8%; P = .04). Conclusion: Pelvic IMRT was associated with significantly less GI and urinary toxicity than standard RT from the patient's perspective.

Original languageEnglish (US)
Pages (from-to)2538-2544
Number of pages7
JournalJournal of Clinical Oncology
Volume36
Issue number24
DOIs
StatePublished - Aug 20 2018

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Radiotherapy
Prostatic Neoplasms
Quality of Life
Radiation
Antidiarrheals
Endometrial Neoplasms
Terminology
Uterine Cervical Neoplasms
Diarrhea

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Klopp, A. H., Yeung, A. R., Deshmukh, S., Gil, K. M., Wenzel, L., Westin, S. N., ... Bruner, D. W. (2018). Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG oncology-RTOG 1203. Journal of Clinical Oncology, 36(24), 2538-2544. https://doi.org/10.1200/JCO.2017.77.4273

Patient-reported toxicity during pelvic intensity-modulated radiation therapy : NRG oncology-RTOG 1203. / Klopp, Ann H.; Yeung, Anamaria R.; Deshmukh, Snehal; Gil, Karen M.; Wenzel, Lari; Westin, Shannon N.; Gifford, Kent; Gaffney, David K.; Small, William; Thompson, Spencer; Doncals, Desiree E.; Cantuaria, Guilherme H.C.; Yaremko, Brian P.; Chang, Amy; Kundapur, Vijayananda; Mohan, Dasarahally S.; Haas, Michael L.; Kim, Yong Bae; Ferguson, Catherine Lowrie; Pugh, Stephanie L.; Kachnic, Lisa A.; Bruner, Deborah W.

In: Journal of Clinical Oncology, Vol. 36, No. 24, 20.08.2018, p. 2538-2544.

Research output: Contribution to journalArticle

Klopp, AH, Yeung, AR, Deshmukh, S, Gil, KM, Wenzel, L, Westin, SN, Gifford, K, Gaffney, DK, Small, W, Thompson, S, Doncals, DE, Cantuaria, GHC, Yaremko, BP, Chang, A, Kundapur, V, Mohan, DS, Haas, ML, Kim, YB, Ferguson, CL, Pugh, SL, Kachnic, LA & Bruner, DW 2018, 'Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG oncology-RTOG 1203', Journal of Clinical Oncology, vol. 36, no. 24, pp. 2538-2544. https://doi.org/10.1200/JCO.2017.77.4273
Klopp, Ann H. ; Yeung, Anamaria R. ; Deshmukh, Snehal ; Gil, Karen M. ; Wenzel, Lari ; Westin, Shannon N. ; Gifford, Kent ; Gaffney, David K. ; Small, William ; Thompson, Spencer ; Doncals, Desiree E. ; Cantuaria, Guilherme H.C. ; Yaremko, Brian P. ; Chang, Amy ; Kundapur, Vijayananda ; Mohan, Dasarahally S. ; Haas, Michael L. ; Kim, Yong Bae ; Ferguson, Catherine Lowrie ; Pugh, Stephanie L. ; Kachnic, Lisa A. ; Bruner, Deborah W. / Patient-reported toxicity during pelvic intensity-modulated radiation therapy : NRG oncology-RTOG 1203. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 24. pp. 2538-2544.
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T1 - Patient-reported toxicity during pelvic intensity-modulated radiation therapy

T2 - NRG oncology-RTOG 1203

AU - Klopp, Ann H.

AU - Yeung, Anamaria R.

AU - Deshmukh, Snehal

AU - Gil, Karen M.

AU - Wenzel, Lari

AU - Westin, Shannon N.

AU - Gifford, Kent

AU - Gaffney, David K.

AU - Small, William

AU - Thompson, Spencer

AU - Doncals, Desiree E.

AU - Cantuaria, Guilherme H.C.

AU - Yaremko, Brian P.

AU - Chang, Amy

AU - Kundapur, Vijayananda

AU - Mohan, Dasarahally S.

AU - Haas, Michael L.

AU - Kim, Yong Bae

AU - Ferguson, Catherine Lowrie

AU - Pugh, Stephanie L.

AU - Kachnic, Lisa A.

AU - Bruner, Deborah W.

PY - 2018/8/20

Y1 - 2018/8/20

N2 - Purpose: NRG Oncology/RTOG 1203 was designed to compare patient-reported acute toxicity and healthrelated quality of life during treatment with standard pelvic radiation or intensity-modulated radiation therapy (IMRT) in women with cervical and endometrial cancer. Methods: Patients were randomly assigned to standard four-field radiation therapy (RT) or IMRT radiation treatment. The primary end point was change in patient-reported acute GI toxicity from baseline to the end of RT, measured with the bowel domain of the Expanded Prostate Cancer Index Composite (EPIC). Secondary end points included change in patient-reported urinary toxicity, change in GI toxicity measured with the Patient-Reported Outcome Common Terminology Criteria for Adverse Events, and quality of life measured with the Trial Outcome Index. Results: From 2012 to 2015, 289 patients were enrolled, of whom 278 were eligible. Between baseline and end of RT, the mean EPIC bowel score declined 23.6 points in the standard RT group and 18.6 points in the IMRT group (P = .048), the mean EPIC urinary score declined 10.4 points in the standard RT group and 5.6 points in the IMRT group (P = .03), and the mean Trial Outcome Index score declined 12.8 points in the standard RT group and 8.8 points in the IMRT group (P = .06). At the end of RT, 51.9% of women who received standard RT and 33.7% who received IMRT reported frequent or almost constant diarrhea (P = .01), and more patients who received standard RT were taking antidiarrheal medications four or more times daily (20.4% v 7.8%; P = .04). Conclusion: Pelvic IMRT was associated with significantly less GI and urinary toxicity than standard RT from the patient's perspective.

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