Predictive factors for toxicity after primary chemoradiation for locally advanced cervical cancer: a systematic review
A partir d'une revue systématique de la littérature publiée entre 1995 et 2023 (73 articles), cette étude identifie des facteurs prédictifs de toxicités gastro-intestinales, génito-urinaires et vaginales ainsi que de fractures par insuffisance osseuse chez des patientes atteintes d'un cancer du col de l'utérus de stade localement avancé traité par chimiothérapie à base de platine et curiethérapie
Résumé en anglais
Purpose: Women with locally advanced cervical cancer (LACC) undergoing primary platinum-based chemoradiotherapy and brachytherapy often experience toxicities. Normal-tissue complication probability (NTCP) models quantify toxicity risk and aid in optimizing radiotherapy to minimize side effects. However, it is unclear which predictors to include in an NTCP model. The aim of this systematic review was to provide an overview of the identified predictors contributing to gastrointestinal (GI), genitourinary (GU), and vaginal toxicities and insufficiency fractures for LACC.
Methods and Materials: A systematic search was performed and articles evaluating the relationship between predictors and toxicities in women with LACC treated with primary chemoradiation were included. The Quality In Prognosis Studies (QUIPS) tool was used to assess risk of bias, with high-risk studies being excluded from further analysis. Relationships between dose-volume parameters, patient and treatment characteristics and toxicity endpoints were analyzed.
Results: 73 studies were identified. 26 had a low or moderate risk of bias and were therefore included. Brachytherapy-related dose-volume parameters of the GI tract, including rectum and bowel EQD2 D2cm3, were frequently related to toxicities, unlike GU dose-volume parameters. Furthermore, (recto)vaginal point doses predicted toxicities. Few studies evaluated external beam radiation therapy (EBRT) dose-volume parameters and identified rectum EQD2 V30Gy, V40Gy, and V55Gy, bowel and bladder EQD2 V40Gy as toxicity predictors. Also, total reference air kerma and vaginal reference length were associated with toxicities. Relationships between patient characteristics and GI toxicity were inconsistent. The extent of vaginal involvement at diagnosis, baseline symptoms, and obesity predicted GU or vaginal toxicities. Only one study evaluated insufficiency fractures and demonstrated lower pretreatment bone densities to be associated.
Conclusions: This review detected multiple candidate predictors of toxicity. Larger studies should consider insufficiency fractures, assess dose levels from EBRT, and quantify the relationship between the predictors and treatment-related toxicities in women with LACC to further facilitate NTCP model development for clinical use.
