Abstract
Background/Purpose
This study describes late bowel morbidity prospectively assessed in the multi-institutional
EMBRACE study on MRI-guided adaptive brachytherapy in locally advanced cervical cancer
(LACC).
Materials/Methods
A total of 1176 patients were analyzed. Physician reported morbidity (CTCAE v.3.0)
and patient reported outcome (PRO) (EORTC QLQ C30/CX24) were assessed at baseline
and at regular follow-up.
Results
At 3/5 years the actuarial incidence of bowel morbidity grade 3–4 was 5.0%/5.9%, including
incidence of stenosis/stricture/fistula of 2.0%/2.6%. Grade 1–2 morbidity was pronounced
with prevalence rates of 28–33% during follow-up. Diarrhea and flatulence were most
frequently reported, significantly increased after 3 months and remained elevated
during follow-up. Incontinence gradually worsened with time. PRO revealed high prevalence
rates. Diarrhea ≥“a little” increased from 26% to 37% at baseline to 3 months and
remained elevated, difficulty in controlling bowel increased from 11% to 26% at baseline
to 3 months gradually worsening with time. Constipation and abdominal cramps improved
after treatment.
Conclusion
Bowel morbidity reported in this large cohort of LACC patients was limited regarding
severe/life-threatening events. Mild-moderate diarrhea, flatulence and incontinence
were prevalent after treatment with PROs indicating a considerable and clinically
relevant burden. Critical knowledge based on the extent and manifestation pattern
of treatment-related morbidity will serve future patient management.
Keywords
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Article info
Publication history
Published online: June 04, 2018
Accepted:
May 17,
2018
Received in revised form:
May 17,
2018
Received:
August 4,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
