Magnitude of the Bladder and Rectal Toxicities in the Patients of Locally Advanced CA Cervix Who Have Received Concurrent Chemoradiotherapy Followed by Cobalt Based Brachytherapy and Quality of Life of the Patients Who Have Completed the Treatment with Chemoradiotherapy Followed by Brachytherapy

Abstract

Introduction: Cervical cancer remains a significant cause of morbidity and mortality among women globally, particularly in developing countries. Concurrent chemoradiotherapy (CCRT) followed by brachytherapy is the standard of care for locally advanced cervical cancer (FIGO stages IIB-IIIB). While this combined modality improves survival, it is associated with treatment-related toxicities, particularly involving the bladder and rectum, which can significantly affect patients' quality of life (QoL). Assessment of both acute and late genitourinary (GU) and gastrointestinal (GI) toxicities is essential to optimize patient management and supportive care. Methods: The study was a prospective observational study conducted at the Department of Radiotherapy, Burdwan Medical College and Hospital, Burdwan, from 1st February 2021 to 31st January 2022. The study population included 60 patients attending the radiotherapy outpatient department with biopsy-proven squamous cell carcinoma of the cervix in locally advanced stages (FIGO Stage IB2-IVA) who received concurrent chemoradiotherapy followed by intracavitary brachytherapy. The study variables assessed were bowel toxicities, bladder toxicities, grading of bladder toxicity, functional scale, symptom scale, and global health scale to evaluate both treatment-related adverse effects and quality of life outcomes. Results: Before treatment, bowel and bladder toxicities were minimal. Following concurrent chemoradiotherapy and brachytherapy, mild bowel issues such as diarrhea (up to 14.5%), rectal discharge (15.8%), and intermittent bleeding (3.6%) peaked at 3 months but improved by 6 and 9 months, with severe complications like obstruction and fistula being rare (1.9%). Bladder toxicities, including mild cystitis, urinary frequency, urgency, and dysuria, followed a similar pattern, with most patients exhibiting grade 0 toxicity and severe events uncommon. Quality of life progressively improved over time, with functional scores increasing from 65.44 ± 12.98 to 81.09 ± 7.94, symptom scores decreasing from 35.05 ± 11.96 to 21.36 ± 8.77, and global health status rising from 48.35±5.98 to 75.67 ± 12.79. Conclusions: Concurrent chemoradiotherapy followed by cobalt-based brachytherapy in locally advanced cervical cancer is effective but associated with measurable bladder and rectal toxicities, mostly mild to moderate in severity. While overall quality of life recovers post-treatment, persistent GU and GI symptoms can negatively impact patient well-being. Continuous monitoring, early management of toxicities, and supportive interventions are crucial to maintain QoL in survivors of cervical cancer.