Assessment of late radiation toxicities and quality of life in patients with pelvic cancer – A cross-sectional study

Objectives: Pelvic malignancies form a large proportion of cancers in India. Radiotherapy is used frequently as a part of multimodality or definitive treatment and is associated with acute and chronic toxicities. The objectives were to assess the number and proportion of patients developing Grade 2 and above pelvic organ late toxicities after completion of therapeutic radiation, the factors associated with developing late toxicities, and patient-reported quality of life. Material and Methods: A total of 502 patients were recruited into this cross-sectional observational study, conducted at the Regional Cancer Centre, JIPMER, from June 2020 to June 2022. Patients were recruited after a minimum of 3 months and up to 5 years after completion of pelvic irradiation. The proportion and factors associated with the development of toxicities and the patient-reported quality of life (EORTC QLQ-c30) were also recorded in a single session, at the time of recruitment, after obtaining informed consent. CTCAE (v5.0) and RTOG grading were used to classify the toxicities. Results: Median follow-up assessment period was 36 months. The distribution of grade 2 and above pelvic organ toxicities was: chronic proctitis (19.1%), chronic cystitis (8.0%), subcutaneous fibrosis (18.1%), vaginal stenosis (14.5%), and pelvic insufficiency fractures (10.4%). Three patients had avascular necrosis of the femur, while another three had a second malignancy. 47.2% (95%CI = 42.8%-51.7%) of patients had at least one late pelvic toxicity. 79.7% of chronic visceral toxicities manifested within 3 years of completion of radiotherapy. Patients with grade 2 and above toxicities and disease relapse had poor scores on all functional quality of life scales. Conclusion: 47.2% of patients reported various grade 2 and above late pelvic organ toxicities. 8 (0.02%) patients developed grade 4 late pelvic toxicities. Factors consistently associated with chronic toxicities were BMI, hypertension, bulky disease, and lower vaginal disease. Diabetes, chemotherapy, and performance status were associated with pelvic insufficiency fractures.