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The Effect of Body Mass Index and Weight Change on Late Gastrointestinal Toxicity in Locally Advanced Cervical Cancer Treated With Intensity-modulated Radiotherapy
  1. Jie Lee, MD*,,,
  2. Chih-Long Chang, MD, PhD§,
  3. Jhen-Bin Lin, MD,
  4. Meng-Hao Wu, MD*,,
  5. Fang-Ju Sun, MS,#,
  6. Chieh-Ju Wu, BS*,
  7. Hung-Chi Tai, MS*,,
  8. Shih-Ming Hsu, PhD and
  9. Yu-Jen Chen, MD, PhD*,
  1. *Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan;
  2. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan;
  3. Department of Medicine, MacKay Medical College, Taiwan;
  4. §Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan;
  5. Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan;
  6. Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; and
  7. #MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
  1. Address correspondence and reprint requests to Jie Lee, MD, Department of Radiation Oncology, MacKay Memorial Hospital, 92, Section 2, Chung Shan North Rd, Taipei, 10449 Taiwan. E-mail: sinus.5706{at} and Shih-Ming Hsu, PhD, Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, No. 155, Section 2, Li-Nong St, Beitou District, Taipei 112, Taiwan, ROC. E-mail: smhsu{at}


Objective To evaluate the effects of body mass index (BMI) and weight change during radiotherapy on the development of toxicity in patients with locally advanced cervical cancer (LACC) treated with intensity-modulated radiotherapy (IMRT).

Methods A total of 245 patients were analyzed after undergoing definitive IMRT treatment between 2004 and 2015 for stage IB2 to stage IVA LACC. The patients were divided into 3 groups: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), and overweight (BMI ≥25.0 kg/m2). The relationships between toxicity, clinical factors, and the bowel dose-volume histogram were analyzed. V45 indicated the bowel volume that received a radiation dose of 45 Gy.

Results The median follow-up period was 63 months. The V45 was similar among the 3 groups. The 5-year rates of grade 3 or higher late gastrointestinal toxicities were 18.6%, 4.0%, and 4.2% for the underweight, normal weight, and overweight groups, respectively (P = 0.002). In the multivariable analysis, underweight (hazard ratio, 13.99; 95% confidence interval, 3.22-60.82; P < 0.001) and weight loss (> −5%) (hazard ratio, 5.91; 95% confidence interval, 1.75-19.98; P = 0.004) were significant predictors of grade 3 or higher-grade late gastrointestinal toxicities.

Conclusion A BMI of less than 18.5 kg/m2 and weight loss (> −5%) were associated with a higher risk of grade ≥3 or higher late gastrointestinal toxicity in patients with LACC treated with definitive IMRT. Future research on the development of a standardized and structured approach to improve the therapeutic ratio for the supportive care of patients with LACC is needed.

  • Cervical cancer
  • Body mass index
  • Weight change
  • Intensity-modulated radiation therapy
  • Toxicity

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  • The authors declare no conflicts of interest.

  • Author contributions: Jie Lee conceived and designed the study; collected, analyzed, and interpreted the data; prepared the draft; and gave final approval of the version to be submitted. Jhen-Bin Lin, Fang-Ju Sun, and Chieh-Ju Wu collected the data, undertook data analysis and interpretation, and performed the statistical analysis. Meng-Hao Wu, Chih-Long Chang, Hung-Chi Tai, and Yu-Jen Chen also performed the statistical analysis and carried out clinical revision of the data. Shih-Ming Hsu critically reviewed the intellectual content and gave final approval of the version to be submitted. All authors read and approved the final manuscript.

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