Qualidade de vida e toxicidade aguda da radioterapia em mulheres com cancer ginecologico : um estudo de coorte prospectivo

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

To investigate the incidence of acute toxicity in radiotherapy, evaluate quality of life (QOL) and identify predicting factors of QOL in a cohort of women with gynecologic cancer. Methods: A prospective cohort study was conducted including 107 women with cervical or endometrial cancer and aged between 18 and 75 years. Women with a history of previous pelvic irradiation were ineligible. Radiotherapy was performed with a 10 MV linear accelerator or cobalt radiation therapy machine using the four-field technique. For patients with anteroposterior pelvic diameter below 17cm, the parallel and opposite field technique was used (anterior and posterior). Total mean pelvic dose was 44.9 Gy, in daily fractions of 1.8-2.0 Gy, five times a week. Patients in stage IIB-IV received a booster dose of 7.20-14.40 Gy in parametria and those with para-aortic and inguinal lymph node involvement received a 25.20-45 Gy dose to this area. For brachytherapy, 4 to 5 insertions in the Nucletron-microSelectron High Dose Rate device were performed, with weekly intervals between insertions and a 4-8 Gy dose. Nineteen patients were treated with radiotherapy and concomitant chemotherapy and 40 with surgery (Wertheim-Meigs, total abdominal hysterectomy with bilateral salpingoophorectomy, total abdominal hysterectomy+lymphadenectomy, hysterectomy) followed by radiotherapy. Acute toxicity was assessed according to the Common Toxicity Criteria and the Radiation Therapy Oncology Group Toxicity Criteria. QOL was measured with the World Health Organization?s Quality of Life instrument-abbreviated-version (WHOQOL-BREF) in three points in time: before and at completion of radiotherapy and at the first follow-up clinical visit thirty days after radiotherapy. QOL scores were assessed by ANOVA for repeat measures. Percentage variation of QOL scores obtained before radiotherapy and in the first clinical visit was compared to control variables using Wilcoxon?s test. Multiple linear regression analysis was used to identify predictors of QOL. Results: Median age of the participants was 60 years. Eighty-nine patients (83.2%) were treated with teletherapy and brachytherapy, eight patients only with teletherapy and 10 with only brachytherapy. Total incidence of acute toxicity was 93.5% and the most frequent toxicities were: lower gastrintestinal (79.6%), genitourinary (74.5%) and upper gastrintestinal (70.4%). Ninety-five women completed the three QOL assessments. A significant increase in QOL scores was observed in the physical and psychological domains, as well as in general health and overall QOL. Upper gastrointestinal toxicity (p=0.043) and previous surgery (p=0.027) negatively affected health, while improvement in vaginal bleeding (p=0.047) positively influenced health. Conclusions: A high incidence of acute toxicity of radiotherapy and improvement in the QOL of gynecologic cancer patients were observed after treatment. Women with upper gastrintestinal toxicity and a history of surgery are at risk for a worse QOL

ASSUNTO(S)

colo uterino - cancer qualidade de vida cancer - radioterapia endometrio

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