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Top Line: RTOG 1203 (TIME-C) randomized patients receiving post-op pelvic radiation for endometrial or cervical cancer to either standard 3D-conformal radiation or IMRT.
The Study: The main goal was to reduce bowel dose (really, bowel toxicity) with IMRT. This was measured as a patient-reported outcome (PRO) at 5 weeks using the bowel domain of EPIC and was found to be significantly lower with IMRT. GI toxicity was also scored using CTCAE by both patients and clinicians. While we are cautioned against over-interpreting differences in patient and clinician reporting, this study gives us a very interesting comparison. There were major differences in both the frequency and severity of reported toxicity. Patients reported significantly higher rates of any abdominal pain (36→ 80%), any diarrhea (75→ 87%), and any fecal incontinence (3→ 57%). Clinician-reported grade 3+ abdominal pain (<3%), diarrhea (<5%), and fecal incontinence (0%) rates were low. In contrast, 22% of women reported at least severe abdominal pain, 43% frequent or constant diarrhea, and 7% frequent incontinence. As with the primary EPIC outcome, IMRT was associated with significantly lower rates of PRO-CTCAE diarrhea and incontinence at the end of radiation. However, again like EPIC, those differences became less over time.
TBL: The reported frequency and perceived severity of acute pelvic radiation toxicity is much greater for patients than their clinicians, highlighting a more distinct (but still short-term) advantage with IMRT. | Yeung, J Clin Oncol 2020