The Study: If you’ve read Thinking, Fast and Slow, you’ll understand the underlying problems with patient reported outcomes. Our “experiencing” and “remembering” selves can arrive at some pretty inconsistent conclusions. Speaking of, let’s take a look at the TIME-C trial that's finally been published. It had a straightforward design: women with either cervical or endometrial cancer receiving adjuvant radiation were randomized to conventional 4-field whole pelvic radiation (WPRT) or intensity-modulated radiation (IMRT). The primary endpoint was the patient-reported change in the bowel domain of the EPIC questionnaire at 5 weeks. Both groups had a big drop in scores (bad), but the drop with WPRT was significantly worse than with IMRT at 5 weeks. Patients in the WPRT arm also had more frequent diarrhea, incontinence, and worse urinary toxicity. But guess what. These changes resulted in no difference in the overall patient reported bother score or quality of life. And if you can remember ASTRO two years ago, you may recall the critiques of this trial by Dr. Chopra from Tata Memorial Centre. Particularly that one about, at 4-6 weeks after radiation, the bowel symptoms in both arms were similar and had basically returned back to baseline. Don’t let eviCore see that last part.
Bottom Line: IMRT compared to conventional whole pelvic radiation reduces the severity of patient reported GI symptoms among women with cervical and endometrial cancers. At least at week 5 of radiation. | Klopp, J Clin Oncol 2018