| dc.description.abstract | BACKGROUND: External beam radiotherapy and chemotherapy have become the standard of care in the management of locally advanced cervical cancer disease. Traditional 2-dimensional radiotherapy, employing a cobalt 60 radioactive source with anteroposterior and posteroanterior fields, has been widely used for the treatment of locally advanced cervical cancer with radiotherapy. However, more precise treatment approaches have emerged, such as 3-dimensional conformal techniques, Intensity-Modulated Radiation Therapy (IMRT) and Volumetric-Arc radiation therapy (VMAT), particularly since the advent and popularization of computers. The former utilizes high-energy photons for targeted delivery to tumor cells, while IMRT and VMAT, which are advanced radiation therapy offer improved conformity to the planning target volume and reduced normal tissue toxicity through utilization of Multileaf collimators. The recent installation of a linear accelerator at the Uganda Cancer Institute in March 2021 has provided patients with the option of receiving either IMRT or 3D- conformal radiation therapy. Generally, IMRT is thought to achieve a higher tumor control and homogeneity with optimum OAR sparing as compared to 3D-CRT thus this study aimed at comparing the dosimetric parameters of IMRT and 3D-conformal radiation therapy for locally advanced cervical cancer at the Uganda Cancer Institute. AIM: To compare the dosimetric parameters of Intensity-Modulated Radiotherapy (IMRT) over 3D-Conformal radiotherapy in the management of locally advanced cervical cancer disease. METHODS: A retrospective study design was used from which data of 30 patients with staged locally advanced cervical cancer disease and had completed EBRT treatment from January 2023 to January 2024. EBRT plans for IMRT and 3D-CRT were generated and data on treatment parameters for PTV D2%, PTV D50%, PTV D 95%, PTV D98%, PTV D99%, Dmax, Dmean, Homogeneity Index and organs at risk constraints; bladder, bone marrow, bowel bag V50, rectum V50 and both the right and left femoral heads was collected. RESULTS: Of the 30 patients assessed, 20 attended to IMRT whereas 10 underwent 3D-CRT treatment. Majority of the patients presented with Stage IIIb (n=21) followed by Stage IIb (n=5) as the second most common staging of the disease. IMRT showed significant lower treatment values for HI (median=0.034 vs 0.088). There was notable reduction of dose median to the organs at risk (bone marrow=50.94, bowel bag (V50) =10.94, rectum V50= 44.74, right femoral head=46.26 and left femoral head=47.40) with3D-CRT offering a better bladder dose control (n=50.18, P=0.005) Data obtained from the small bowel, particularly the bowl bag was very significant (p=0.03) as compared to that of 3D-CRT.
CONCLUSION: IMRT offered better dosimetric superiority as compared to 3D-CRT and was attributed with more uniform dose distribution and OAR sparing. | en_US |
