Definitive intensity-modulated radiation therapy with concurrent chemotherapy for patients with locally advanced cervical cancer

Abstract

Objective Cervical cancer is one of the most common cancers diagnosed in women worldwide. Concurrent chemoradiotherapy (CCRT) is the mainstay treatment for locally advanced cervical cancer. The purpose of this study was to investigate the treatment outcomes and toxicity of definitive intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy for patients with locally advanced carcinoma of the cervix in a single institution. Methods Between January 2004 and November 2008, 109 patients with stage IB2–IVA cervical carcinoma treated with IMRT and concurrent cisplatin-based chemotherapy were evaluated retrospectively. All patients received external irradiation of 45–54 Gy with an IMRT technique. High dose rate brachytherapy of 20–33.5 Gy was prescribed to point A as a local boost. Each patient received concurrent cisplatin-based chemotherapy monthly or weekly. The endpoints were overall survival (OS), local failure-free survival (LFFS) and disease-free survival (DFS). Patients were assessed for acute toxicity weekly according to the Common Toxicity Criteria for Adverse Events (CTCAE), version 3.0. Late toxicity was evaluated according to RTOG-EORTC Late Radiation Morbidity Scoring Schema. Results The median follow up time for all surviving patients was 32.5 months, with a range from 5 to 75 months. The 3-year OS, LFFS and DFS were 78.2%, 78.1% and 67.6%, respectively. Three (2.7%) patients developed grade 3 or greater acute gastrointestinal (GI) toxicity and 26 (23.9%) patients developed grade 3 or greater hematological toxicity. Five (4.6%) patients developed grade 3 or greater chronic GI toxicity and 7 (6.4%) patients developed grade 3 or greater genitourinary system toxicity. Conclusions Good outcomes were achieved with definitive IMRT and concurrent chemotherapy for patients with locally advanced cervical cancer and the combined treatment was well tolerated with favorable acute and late toxicity.