Abstract
Purpose: To determine the long-term oncologic outcomes and toxicity of patients treated with definitive chemo-radiotherapy for cervical cancer. Methods and Materials: The study period was January 1, 2000 to December 31, 2009. All patients diagnosed with cervical cancer who received curative-intent chemoradiotherapy were included. Patients were excluded if they resided out of the province, received surgery as an initial treatment, or were treated with palliative intent. A retrospective chart review was performed.Results: Four hundred and eighty-six patients were diagnosed with cervical cancer; 190 met eligibility criteria. Median follow-up for all patients was 3.2 years (interquartile range 1.1—5.6 years). Clinical stage was FIGO IIB or higher in 139 of 190 patients (73.2%). One hundred and fifty-eight (82.7%) received concurrent cisplatin chemotherapy (mean # cycles = 4.8). The most common external beam radiotherapy (EBRT) dose/fractionation schedule was 45 Gray (Gy) in 25 fractions (149 pts, 78.0%). One hundred and thirty-six (71.2%) received low-dose-rate (LDR) brachytherapy (BT: most common dose = 35 Gy). High-dose-rate (HDR) BT was implemented in 2008; the most common HDR dose was 24 Gy in 8 fractions over five days. Five-year overall survival (OS) and progression-free survival (PFS) were 69.4% and 61.4%, respectively. OS and PFS were significantly higher in patients who received chemotherapy vs. radiotherapy alone. For those receiving HDR-BT, there was a significantly higher OS, but not PFS. The rate of late RTOG Grade 3/4 toxicity at five years was 23.3% (gastrointestinal - 26 events, 13% of patients; genitourinary - 13 events, 8% of patients). Fourteen patients had Grade 3 radiation proctitis as the only late toxicity. EBRT dose above 45 Gy was the only factor associated with late toxicity on multivariate analysis.Conclusion: Outcomes of patients treated with chemoradiotherapy for cervical cancer are in keeping with those reported in other series. Chemotherapy improved OS and PFS. External beam radiotherapy dose above 45 Gy was the only predictor of late toxicity.
Highlights
Cervical cancer is a common cause of death for young women in Canada [1]
Four hundred and eighty-six patients were diagnosed with cervical cancer during the study period
This study reports the incidence, outcomes, and late effects in patients treated for cervical cancer with external beam radiotherapy and brachytherapy in a Canadian province
Summary
External beam radiotherapy and brachytherapy have long been considered the standard of care for patients with locally advanced cervical cancer. In the last 20 years, there have been two major changes in the care of patients receiving radiotherapy for cervical cancer with curative intent: the introduction of concurrent chemotherapy and the transition from low-dose-rate (LDR) to high-dose-rate (HDR) brachytherapy. Several randomized controlled trials in the 1990s demonstrated improvements in overall survival with the addition of concurrent cisplatin chemotherapy to standard radiotherapy [3]. This resulted in a National Cancer Institute (NCI) alert in 1999, which recommended widespread adoption of concurrent chemoradiotherapy [4]. Many radiotherapy centres worldwide adopted HDR brachytherapy during this time period, and HDR is widely used in Canada [5]
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