Comparison of Acute Hematological Toxicities Between Three-Dimensional Conformal Radiotherapy (3DCRT) and Intensity-Modulated Radiotherapy (IMRT) in Locally Advanced Cervical Cancer

BackgroundPelvic external beam radiotherapy (EBRT) with concurrent chemoradiotherapy followed by brachytherapy is regarded as the standard treatment for locally advanced cervical cancer.Hematologic toxicities are commonly associated with this treatment.The purpose of this study was to assess and compare acute hematological toxicities between three-dimensional conformal radiotherapy (3DCRT) and intensitymodulated radiotherapy (IMRT) techniques of EBRT. Materials and methodsThis quasi-experimental study was conducted from October 2021 to September 2022, during which 70 patients with locally advanced squamous cell carcinoma of the uterine cervix were divided into two treatment arms (A and B), 35 patients in each arm, by purposive sampling.Patients in Arm A and Arm B received EBRT by 3DCRT and IMRT techniques, respectively, with concurrent chemotherapy, and the rest of the treatment was the same.All patients were evaluated before starting radiotherapy, weekly during therapy, and after completing treatment.Follow-ups were done after completion of EBRT, then after completion of intracavitary irradiation (ICRT), and finally six weeks after the completion of treatment (EBRT and ICRT) using history, clinical examination, and investigations. ResultsDuring EBRT, the overall incidence of hematological toxicities was significantly higher in arm A than in arm B (97.14% vs 77.14%, p = 0.012).Leukopenia was also significantly more frequent in arm A (65% vs 34%, p = 0.05).The incidences of anemia, neutropenia, or thrombocytopenia were not significantly different between the arms.Following completion of ICRT, the overall incidence of hematological toxicity remained significantly higher in Arm A than in Arm B (97.14% vs 71.43%, p = 0.006).Among the individual hematological toxicities, only anemia showed a statistically significant difference between the two groups, occurring more frequently in Arm A (85.7% vs 51.4%, p = 0.002) in this case.No statistically significant differences were observed in hematologic toxicities between the arms during follow-ups at week 9 and week 15. ConclusionThe study findings favor the IMRT technique over 3DCRT for decreasing acute hematological toxicities of radiotherapy.