Background: Studies describing patient factors associated with radiation toxicity in cervical cancer (CxCa) treatment predate advancements in the delivery of radiotherapy. This study identifies factors that correlate with severe late gastrointestinal and or genitourinary toxicity (SLT) in women with CxCa treated with radiation using modern techniques. Methods: CxCa patients treated with radiation from 2005 to 2017 in a single academic institution were included. Records were reviewed for demographic information, Charlson comorbidity index (CCI), treatment details, toxicities and outcomes. Characteristics of patients with and without SLT were compared. Results: Of 185 patients identified, 21.6% had SLT; 17.8% had gastrointestinal toxicity and 10.8% had genitourinary toxicity. The mean duration of follow up was 37 (1-146) months. The majority of patients (84.3%) received 3-dimensional conformal therapy (3D), and 21% received intensity-modulated radiation therapy (IMRT). Factors associated with SLT were lower BMI (24.6 vs 28.7, p < 0.001), White race (62.5% vs 43.4%, p = 0.03), and smoking (59.0% vs 39.7%, p = 0.03). SLT was not associated with total dose, 3D versus IMRT planning, or time to complete therapy. Patients with SLT had PFS and OS similar to those without toxicity. Conclusions: In CxCa patients, radiation toxicity correlated with lower BMI, White race and smoking. Even with modern radiotherapy planning and delivery, toxicity rates are high, and interventions to reduce the burden of treatment are needed.Table 1:

*p < 0.05