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of G≥1 limb edema significantly (p≤0.001) with an
actuarial risk at 5 years of 23.8% versus 47.1% (figure 2).
Conclusion
Moderate to severe limb edema G≥2 is limited in the first
years after definitive radiochemotherapy including MRI-
guided adaptive brachytherapy. Mainly mild limb edema
CTCAE G1 with 5-10% inter-limb discrepancy in volume or
circumference at point of greatest visible difference is
observed. Nevertheless, a proportion of 8-14% of patients
reports “quite a bit” and “very much” swelling of one or
both legs during follow-up. Limb edema shows a
progressive manifestation pattern over time both in the
physician assessed and the patient reported outcome.
Laparoscopic lymph node staging bears a considerable risk
for the development of G≥1 limb edema. Further
investigations are needed to evaluate various specific risk
factors in a multivariate model.
OC-0054 Dynamics of patient reported QoL and
symptoms after IGRT for locally advanced cervical
cancer
S.T. Heijkoop
1
, R.A. Nout
2
, S. Quint
1
, J.W.M. Mens
1
,
B.J.M. Heijmen
1
, M.S. Hoogeman
1
1
Erasmus MC Cancer Institute, Radiation Oncology,
Rotterdam, The Netherlands
2
Leiden University Medical Center, Radiation Oncology,
Leiden, The Netherlands
Purpose or Objective
In this study, locally advanced cervical cancer patients are
treated with an online adaptive Plan-of-the-Day (PotD)
protocol, using a daily CBCT to select the plan that best
fits the observed anatomy of that day from a patient-
specific plan library. The objective is to reduce
unnecessary dose to healthy normal organs and to
maintain a favorable Quality of Life (QoL). Patient
reported health-related QoL and symptoms, during and in
the first year after treatment, were prospectively scored.
Results are reported here.
Material and Methods
Between January 2012 and March 2016, all locally
advanced cervical cancer patients treated with the PotD
protocol and brachytherapy with or without chemotherapy
or hyperthermia were eligible. QoL was assessed at
baseline; weekly during the first five weeks of treatment;
1 week and 1, 3, 6 and 12 months after treatment, using
the EORTC QLQ-C30 and the QLQ-CX24 questionnaires.
Comparisons were made with an age-matched norm
population.
Results
From January 2012 until March 2016 a total of 167 locally
advanced cervical cancer patients were treated with a
PotD protocol, of which 123 (74%) were included as
responders (baseline score and at least 1 additional
questionnaire). Scores of EORTC QLQ-C30 functioning and
global health scales are shown in figure 1. At baseline,
scores of all functional scales except global health status
were lower compared to the age-matched norm
population. Global health and functioning were
temporarily decreased and returned to a plateau at
baseline level 3 months after treatment, except for
cognitive functioning. Compared to the norm population
all functioning scores, except global health showed either
a small decrease or a medium decrease (cognitive
functioning) 1 year after treatment.
Scores of symptoms and sexual functioning are provided in
figure 2. Most symptoms showed a moderate-to-large
increase, reaching a maximum at the end of treatment (5
th
week), or first week after treatment with a return to
baseline at 3 months. However, several symptoms
persisted during further follow-up (diarrhea, bowel
cramps, dysuria, pain, fecal leakage, insomnia, tingling/
numbness). While most symptoms gradually increased
during the first five weeks, diarrhea and bowel cramps
already markedly increased within the first three weeks to
reach a plateau at the 5
th
week of treatment. Sexual/
vaginal symptoms became apparent after treatment and
increased in the first year after treatment. The increased
vaginal symptoms were paralleled by increased sexual
worrying and decreased sexual enjoyment.