FIGO Stage IIB Cervical Cancer Research Articles

Concurrent Chemoradiotherapy Compared With Neoadjuvant Chemotherapy Followed by Radical Hysterectomy for FIGO Stage IIB Cervical Cancer Patients: A Systematic Review and Meta-analysis [ID 2683429

INTRODUCTION: Cervical cancer is the fourth most common malignant disease and cause of cancer death in women worldwide. FIGO stage IIB includes cervical carcinomas with invasion of the parametria. Despite innovative treatment approaches, recurrence and mortality rates among patients with locally advanced cervical cancer (LACC) have not been significantly reduced. The current treatment recommendation for FIGO stage IIB is concurrent chemoradiotherapy (CCRT). Neoadjuvant chemotherapy followed by radical hysterectomy (NACT+HE) represents a valid alternative. METHODS: According to the PRISMA guidelines and Cochrane handbook recommendations, we systematically searched the following databases up to January 2023: PubMed, Scopus, Web of Science, and Cochrane CENTRAL for relevant studies and reports that compare NACT+HE versus CCRT for patients with LACC and specifically with FIGO stage IIB. RESULTS: Our search results revealed 1,034 records, of them only 6 studies (n=2,055); 2 clinical trials and 4 observational cohorts were eligible to be included in both qualitative and quantitative analyses. Patients with FIGO stage IB2–IVA showed no advantage for 5-year overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS) with NACT+HE compared to CCRT (hazard ratio [HR] 0.66 [95% CI: 0.43–1.01]; HR 0.62 [95% CI: 0.23–1.65]; and HR 0.88 [95% CI: 0.51–1.50]). A subgroup analysis for patients with FIGO stage IIB showed a significantly better 5-year DFS for CCRT compared to NACT+HE (HR 1.86 [95% CI: 1.23–2.81]); however, no significant improvement was shown for 5-year OS and 5-year PFS (HR 0.88 [95% CI: 0.52–1.49] and HR 0.85 [95% CI: 0.56–1.29]), respectively. CONCLUSION: This meta-analysis did not show any advantage for women with LACC treated with the NACT+HE approach compared to those treated with the CCRT approach. However, in a stage-specific analysis of patients with FIGO stage IIB cervical cancer, CCRT was superior to NACT+HE in terms of DFS, whereas no significant difference was shown for OS or PFS.

Neoadjuvant Chemotherapy Followed by Surgery in Figo Stage IB2, IIA2, and IIB Cervical Cancer—Survival Analysis

Neoadjuvant Chemotherapy Followed by Surgery in Figo Stage IB2, IIA2, and IIB Cervical Cancer—Survival Analysis

Neoadjuvant chemotherapy followed by radical surgery versus concurrent chemoradiotherapy in patients with FIGO stage IIB cervical cancer

Objective: The aim of this study was to compare the long-term survival of patients with FIGO stage IIB cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy (NACT + RS) with the survival of those treated with concurrent chemoradiotherapy (CCRT).

Neoadjuvant chemotherapy followed by radical surgery versus concurrent chemoradiotherapy in patients with FIGO stage IIB cervical cancer: the CSEM 006 study

BackgroundConcurrent chemoradiotherapy is the first-line treatment for FIGO stage IIB cervical cancer. Neoadjuvant chemotherapy followed by radical surgery may provide another treatment option.Primary objectiveTo compare the therapeutic outcomes of neoadjuvant...

Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center.

PurposeAlthough definitive chemoradiotherapy is considered as a standard of care for FIGO stage IIB cervical cancer in many countries, the role of surgery remains controversial. We aimed to evaluate the feasibility and outcomes of patients with FIGO stage IIB cervical cancer who received radical surgery in China.Patients and methodsA total of 74 women with FIGO stage IIB cervical cancer were treated with radical hysterectomy, with or without adjuvant radio/chemoradiotherapy, at the Obstetrics and Gynecology Hospital of Fudan University between 2004 and 2015. Medical charts and clinical data were retrospectively reviewed. The Kaplan–Meier method and Cox regression models were used for survival analyses. In addition, prognostic nomograms predicting overall survival (OS) and progression-free survival (PFS) were constructed.ResultsPathological parametrial involvement (PMI) was only identified in 28.3% (21/74) of all patients and 47.3% (9/19) of patients without neoadjuvant treatment. Major surgical complications, including bladder fistula, intestinal obstruction and ureteral injury, were found in 6.8% (5/74) of patients. Although the use of imaging technologies including magnetic resonance imaging (MRI)/positron emission tomography–computed tomography (PET–CT) has increased after 2010 compared to that prior to 2010, the accuracy of MRI/PET–CT in detecting pathological PMI was lower than that of physical examination under anesthesia (P<0.05). Neoadjuvant treatment was the only risk factor affecting the accuracy of pre- and postoperative accordance of PMI (OR: 3.283 [95% CI: 1.363–7.908], P=0.008). The 2- and 5-year OS rates were 84.1% and 68.9%, respectively, while the 2- and 5-year cumulative recurrence rates were 26.9% and 39.9%, respectively. Cox regression analyses indicated that pre- and postoperative accordance of PMI, common iliac lymph node metastasis and major surgical complications were significant prognostic factors for both OS and PFS.ConclusionRadical hysterectomy might be a feasible alternative for FIGO stage IIB cervical cancer. As pre- and postoperative accordance of PMI is relatively low, strategies to appropriately select patients who will benefit from surgery via pretreatment evaluation need to be further investigated.

Phase II study of perioperative combination chemotherapy with triweekly carboplatin and weekly dose dense paclitaxel and radical hysterectomy for locally advanced cervical cancer (SGSG-016 study).

e17022 Background: The primary objective of this study was to assess efficacy and safety of triweekly carboplatin plus weekly dose dense paclitaxel (ddTC therapy) before and after radical hysterectomy without radiotherapy (RH) for women with locally advanced cervical cancer. Methods: Patients with FIGO stage IB2, IIA2, or IIB cervical cancer received 3 cycles of carboplatin at an area under the curve of 6 on day 1 and paclitaxel at 80mg/m2on day 1, 8, and 15 every 21 days followed by RH. Patients with one or more high-risk factors for recurrence including lymph vascular invasion, parametrial invasion, lymph node matastasis, or positive margin received additional 3 cycles of ddTC therapy after RH. Results: Between September 2014 and July 2016, 50 women including 13 with FIGO stage Ib2, 5 with stage IIa2, and 32 with stage IIb were enrolled in this study. There were 37 squamous cell carcinoma, 10 adenocarcinoma, 2 adenosquamous carcinoma, and 1 large cell neuroendocrine carcinoma. Median age was 46 years (range 30-78). Forty-three women (86%) completed planed 3 cycled of chemotherapy before surgery. The overall response rate was 92% (18 complete response, 28 partial response, 3 stable disease, 1 progressive disease). Forty-nine patients (98%) completed planed radical hystsrectomy, but a patient with invasion to bladder musculature received concurrent radiation therapy instead of surgery. Eleven patients (22%; 10 with SCC, 1 with large cell neuroendocrine carcinoma) achieved pathological complete response. Eleven other patients with one or more high-risk factors received 3 cycles of ddTC therapy after surgery. Grade 3/4 hematological toxicities included neutrocytopenia (58%), thrombocytopenia (2%) and anemia (24%). One patients experienced neutropenic fever. Grade 3/4 non-hematological toxicities were observed in 4 patients (1, grade 3 nausea; 1, grade3 carboplatin allergy; 1, grade 3 paclitaxel allergy; 1 grade 3 elevetaed liver enzyme). Conclusions: Administration of ddTC therapy before and after RH has good efficacy and acceptable toxicity in women with locally advanced cervical cancer. Clinical trial information: UMIN000024136.

A volumetric analysis of GTVD and CTVHR as defined by the GEC ESTRO recommendations in FIGO stage IIB and IIIB cervical cancer patients treated with IGABT in a prospective multicentric trial (EMBRACE)

PurposeTo quantify the gross tumor volume at diagnosis (GTVD) and high-risk clinical target volume (CTVHR) at brachytherapy (BT) and describe subgroups of patients with different patterns of response to chemoradiotherapy (CRT) in patients with FIGO stage IIB and IIIB cervical cancer treated with image-guided adaptive brachytherapy (IGABT). Additionally, to evaluate the feasibility of IGABT achieving adequate target coverage in these groups. Materials and methodsPatients with FIGO stage IIB and IIIB cervical cancer enrolled in the EMBRACE study were analyzed. T2-weighted MRI scans were obtained at diagnosis and at BT. GTVD and CTVHR were defined as per the GEC ESTRO recommendations. Patients were classified taking into account that initial tumor volume and response to CRT represented by the volume of residual disease (CTVHR) and extent of residual parametrial disease are all major factors determining local dose delivery by BT, local control, and overall disease outcome. These factors were quantified applying the following criteria: (1) volume of the GTVD relative to the median volume of the GTVD; (2) the ratio (R) of CTVHR to GTVD for each patient; (3) the extent of residual parametrial disease at the time of BT. Accordingly, patients were classified into six groups (G1–G6): stage IB1-like tumors (G1), tumors with good response and any size (G2), small tumors with moderate response (G3), large tumors with moderate response (G4), tumors with poor response (G5) and those with progressive disease (G6). Tumor and treatment characteristics were then compared among the first five groups (only 3 patients were allocated to G6). ResultsA total of 481 patients were evaluated. The number of patients in the 6 groups were 55, 78, 123, 147, 75 and 3, respectively. The mean (SD) GTVD was 43.6 (32.8)cm3 and the mean (SD) CTVHR was 31.6 (16.1)cm3. The mean GTVD and CTVHR were 12.6cm3 and 23.7cm3 in G1 (R>1.1), 47.5cm3 and 25.3cm3 in G2 (R<0.9), 23.9 cm3 and 29.9cm3 in G3 (R 0.9–1.1), 73.4cm3 and 38.5cm3 in G4 (R 0.9–1.1), 79.4cm3 and 59.5cm3 in G5 (R>1.1), respectively. Parametrial disease extent at BT was as follows: no involvement in G1 and G2, proximal at most in G3 and G4, distal or to the pelvic wall in G5, progressive in G6. The use of interstitial needles was progressively higher among the groups (mean 0, 0, 2, 3, 6 in G1–5, P<0.001). The mean GTVBT D100 in G1-5 was 103.1Gy, 91.8Gy, 93.5Gy, 88.3Gy and 87.1Gy. The mean CTVHR D90 in G1-5 was 95.1Gy, 92.1Gy, 92.6Gy, 87.6Gy and 88.4Gy. ConclusionsIn patients with FIGO stage IIB and IIIB disease, intra-FIGO stage heterogeneity and overlap between the two stages exist with respect to tumor volume, treatment response and extent of parametrial disease at BT. Taking into account GTVD, parametrial disease at BT and the ratio of CTVHR/GTVD, five major groups exist. These enable prediction of GTVBT and CTVHR dose coverage through BT. IGABT, as performed in EMBRACE, accommodates to a considerable degree for the different variants of tumor regression in these groups through adaptation of the treatment technique including the use of needles. However, major variations remain at present with regard to dose to GTVBT and to CTVHR, which are most pronounced in G4 and G5. This new classification will be validated in future in regard to clinical outcome in EMBRACE.

Adverse impact of bulky (≥ 2 cm) pelvic lymph node involvement determined by magnetic resonance imaging in FIGO stage IIB cervical cancer patients treated with primary concurrent chemoradiation therapy

Adverse impact of bulky (≥ 2 cm) pelvic lymph node involvement determined by magnetic resonance imaging in FIGO stage IIB cervical cancer patients treated with primary concurrent chemoradiation therapy

Cost-effectiveness of radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer.

ObjectiveRecent literature reports that radical hysterectomy followed by adjuvant radiotherapy has comparable progression-free survival and overall survival compared to radical radiotherapy for International Federation of Gynecology and Obstetrics stage IIB cervical cancer. Now, we evaluate the cost-effectiveness (CE) of these two treatment regimens.Primary and secondary outcome measuresA decision-tree model was constructed comparing CE between treatment arms using the published studies for overall survival rates and treatment-related toxicity rates for 5 years. The cost data were obtained from the hospital system of the First Affiliated Hospital of Xi’an Jiaotong University. Effectiveness was measured as quality-adjusted life year (QALY). Treatment arms were compared with regard to costs and life expectancy using incremental CE ratio, and the results were presented using costs per QALY.ResultsThe mean cost was $10,872 for radical hysterectomy followed by adjuvant radiotherapy versus $5,702 for radical radiotherapy. The incremental CE ratio for surgery-based treatment compared to radiotherapy-based treatment was –$76,453 per QALY.ConclusionRadical radiotherapy would be a cost-effective method for FIGO stage IIB cervical cancer and would be favored in settings where resources are limited.

Assessment of Parametrial Response by Growth Pattern in Patients With FIGO Stage IIB and IIIB Cervical Cancer: Analysis of Patients From a Prospective Multicentric Trial (EMBRACE)

Assessment of Parametrial Response by Growth Pattern in Patients With FIGO Stage IIB and IIIB Cervical Cancer: Analysis of Patients From a Prospective Multicentric Trial (EMBRACE)

Californium versus cobalt brachytherapy combined with external-beam radiotherapy for IIB stage cervical cancer: long-term experience of a single institute.

PurposeThe purpose of this paper was to observe and compare long-term curative effects and complications of FIGO stage IIB cervical cancer patients (n = 232) treated with high-dose-rate (HDR) californium (252Cf) neutron or cobalt (60Co) photon intracavitary brachytherapy (ICBT) combined with external-beam radiotherapy (EBRT).Material and methodsThe EBRT dose to the small pelvis was 50 Gy in both groups. The brachytherapy component of 252Cf or 60Co was added in the 3rd week of EBRT, 5 fractions were performed once per week resulting in a total ICBT dose of 40 Gy/Gyeq (point A).ResultsOverall survival (OS) at 5, 10 and 15 years was 63.6%, 50.4% and 38.8% in the 252Cf group and 62.2%, 50.5%, 39.9%, in the 60Co group, respectively (p = 0.74). The percentage of tumour recurrence was statistically significantly lower in the 252Cf group with 7.4% versus 17.1% in the 60Co group (p = 0.02). Second primary cancers have developed similarly 9.1% and 8.1% cases for 252Cf and 60Co groups, respectively.ConclusionsOur long-term retrospective study comparing 252Cf and 60Co isotopes with brachytherapy in combined treatment of FIGO IIB stage cervix carcinoma patients shows, that overall survival in the both groups are similar. However, the recurrence of tumour was significantly lower in the 252Cf group. The incidence of second primary cancers was similar in both groups.

Outcome of Image Guided Brachytherapy in Locally Advanced Cervical Cancer Within a Multi-institutional Retrospective Cohort

described in the Table. Patients’ age, tumor histology, degree of differentiation, and chemotherapy administration were all equally distributed between the four groups. The rate of spread to lymph nodes was significantly higher in Group 4 (37%, 31%, 54%, 74% in Groups 1-4, respectively; P < 0.001). The use of interstitial needles was significantly higher in Groups 3 and 4 (19%, 3%, 41%, 89% in Groups 1-4, respectively; P < 0.001). The mean HR CTV D90 in EQD2 was 93.4 Gy, 93.9 Gy, 89.2 Gy, and 87.4 Gy in Groups 1-4, respectively. Conclusions: FIGO stage IIB cervical cancer is a heterogenous group with significant variation in tumor size. Four different patterns of tumor response can be identified, with the majority of patients responding favorably to radiation therapy. IGABT has the potential to accommodate the different variants of tumor regression including those with major residual disease at time of BT. Author Disclosure: N.T. Jastaniyah: None. K. Yoshida: None. K. Tanderup: None. J. Lindegaard: E. Research Grant; Research grant from Varian, CIRRO e The Lundbeck Foundation Center for Investigational Research in Radiation Oncology. F. Patel: None. P. Petric: None. B. Segedin: None. C. Haie-Meder: None. R. Cooper: None. R. Potter: None.

A Volumetric Analysis of GTVD and HR CTV as Defined by the GEC ESTRO Recommendations in FIGO Stage IIB Cervical Cancer Patients Treated With IGABT in a Prospective Multicentric Trial

A Volumetric Analysis of GTVD and HR CTV as Defined by the GEC ESTRO Recommendations in FIGO Stage IIB Cervical Cancer Patients Treated With IGABT in a Prospective Multicentric Trial

Clinical effects of concurrent radiochemotherapy followed by radical surgery and radical radiotherapy with concurrent chemotherapy: a comparative study of 243 patients with FIGO stage IIB cervical cancer

Objective To compare concurrent radiochemotherapy (CRCT) followed by radical surgery and radical radiotherapy (RT) with concurrent weekly cisplatin in terms of survival rates and longterm toxicities in patients with FIGO stage ⅡB cervical cancer.Methods A retrospective analysis was performed on 243 patients with FIGO stage ⅡB cervical cancer who were admitted to our hospital from November 2004 to November 2011.Of the 243 patients,121 patients received CRCT followed by radical surgery (group 1),and 122 received radical RT with concurrent chemotherapy (weekly cisplatin,40 mg/m2) (group 2).The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for survival difference analysis ; the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％ in groups 1 and 2.34 and 33 patients were followed up for at least 3 years in groups 1 and 2.The 3-year progression-free survival (PFS) rates,overall survival (OS) rates,and local control rates for groups 1 and 2 were 91.5％ vs 82.0％ (P =0.013),95.5％ vs 89.2％ (P =0.085),and 96.7％ vs 93.4％ (P =0.375),respectively.In group 1,the patients with a tumor diameter of ≥6 cm and an age of ≤35 years had a significantly lower 3-year PFS rate than those with a tumor diameter of ＜ 6 cm and an ageof＞35 years (68.2％ vs 93.8％,P=0.004;74.1％ vs 93.2％,P=0.037).In group 2,the patients with non-squamous cell carcinoma and a tumor diameter of ≥6 cm had a significantly lower 3-year PFS rate than those with squamous cell carcinoma and a tumor diameter of ＜ 6 cm (50.0％ vs 83.0％,P =0.013 ;25.0％ vs 86.0％,P =0.002).In groups 1 and 2,the patients with a tumor diameter of ≥6 cm had a significantly lower 3-year OS rate than those with a tumor diameter of ＜ 6 cm (78.8％ vs 97.0％,P =0.033 ;46.9％ vs 92.6％,P =0.007).Leg edema occurred more frequently in group 1 than in group 2 (33.1％ vs 8.2％,P=0.000),while radiation enteritis more frequently in group 2 than in group 1 (31.2％ vs 5.0％,P =0.000).Conclusions CRCT followed by radical surgery may lead to better PFS than radical RT with weekly cisplatin in patients with FIGO stage ⅡB cervical cancer.Tumor diameter is the common prognostic factor for PFS in patients who receive the two treatments. Key words: Cervical neoplasms/surgery; Cervical neoplasms/concurrent chemoradiotherapy; Prognosis

Radical hysterectomy with adjuvant radiotherapy versus definitive radiotherapy alone for FIGO stage IIB cervical cancer

ObjectivesThe aim of this study was to compare the treatment outcomes and adverse effects of radical hysterectomy followed by adjuvant radiotherapy with definitive radiotherapy alone in patients with FIGO stage IIB cervical cancer. MethodsWe retrospectively reviewed the medical records of FIGO stage IIB cervical cancer patients who were treated between April 1996 and December 2009. During the study period, 95 patients were treated with radical hysterectomy, all of which received adjuvant radiotherapy (surgery-based group). In addition, 94 patients received definitive radiotherapy alone (RT-based group). The recurrence rate, progression-free survival (PFS), overall survival (OS), and treatment-related complications were compared between the two groups. ResultsRadical hysterectomy followed by adjuvant radiotherapy resulted in comparable recurrence (44.2% versus 41.5%, p=0.77), PFS (log-rank, p=0.57), and OS rates (log-rank, p=0.41) to definitive radiotherapy alone. The frequencies of acute grade 3–4 toxicities were similar between the two groups (24.2% versus 24.5%, p=1.0), whereas the frequencies of grade 3–4 late toxicities were significantly higher in the surgery-based group than in the RT-based group (24.1% versus 10.6%, p=0.048). Cox multivariate analyses demonstrated that treatment with surgery followed by adjuvant radiotherapy was associated with an increased risk of grade 3–4 late toxicities, although the statistical significance of the difference was marginal (odds ratio 2.41, 95%CI 0.97–5.99, p=0.059). ConclusionsDefinitive radiotherapy was found to be a safer approach than radical hysterectomy followed by postoperative radiotherapy with less treatment-related complications and comparable survival outcomes in patients with FIGO stage IIB cervical cancer.

Radical hysterectomy for FIGO stage IIB cervical cancer: Clinicopathological characteristics and prognostic evaluation

Objective To clarify the clinicopathological features and prognostic factors of patients with FIGO stage IIB cervical cancer who were treated with radical hysterectomy. Methods One hundred thirty-nine FIGO stage IIB patients with squamous or adenosquamous cell carcinoma (median age, 51 years) who were treated with primary radical hysterectomy were examined retrospectively. Sixty-six FIGO stage IIB patients who were treated with primary radiotherapy (median age, 70 years) were included for comparison of survival. Results Fifty percent (70/139) of the patients had pathological parametrial involvement. Among them, the positive rate of pelvic lymph nodes was 71% (50/70). Ninety-nine percent (138/139) of the tumors were completely removed, and the pelvic control rate was 88%. Major complications requiring surgery were found in 2.9% (4/139). Significant differences in survival were found among patients in subgroups according to pathological parametrial involvement, pelvic lymph node status, tumor size, lymph–vascular space invasion, and depth of myometrial invasion (log-rank test, P < 0.05). Of these, the Cox proportional-hazard model revealed that parametrial involvement ( P = 0.001, 95% CI 1.992–6.297) and lymph node metastasis ( P = 0.042, 95% CI 1.023–3.298) were independent prognostic factors. The 5-year survival rate and relapse-free survival at 36 months were 69% and 72% among the radical hysterectomy group, and 69% and 75% among the radiotherapy group. The Cox model adjusted for age showed no significant differences in survival and relapse-free survival between these two groups. Conclusion Pathological parametrial involvement and positive nodes were prognostic factors for surgically treated patients with FIGO stage IIB cervical cancer.

Effect of concurrent chemoradiotherapy with cisplatin and 5-fluorouracil for FIGO stage IIB of the uterine cervix

Objective : To determine effect of concurrent chemoradiotherapy (CCRT) in treatment of FIGO stage IIB cervical cancer the uterus and of consolidation chemotherapy using same chemotherpeutic regimens. Methods : The study population consisted of total number of 41 patients diagnosed as having cervical cancer FIGO stage IIB between January 1999 and December 2003 and treated with CCRT. We were divided into 2 groups according to number of cycles of chemotherapy received [e.g., ≤3 (n=19, cases) cycles versus >3 (n=22, controls) cycles]. Both groups had received the chemotherapeutic regimens which consist of cisplatin 60㎎/㎡ followed by five consecutive daily infusions of 5-fluorouracil (5-FU) 1,000㎎/㎡ every 3 weeks. Results : 5 years survival rate and 3 years progression free survival are 80.1% and 60.6% in 45 months median follow up duration (range 6-81 months). The median duration of follow up for case and control is 42 months (range 6-81 months) and 52.5 months (range 11-74 months) respectively (p=0.89). Both progression free survival rate (p=0.77) and survival rate (p=0.39) of the groups were revealed to be without statistical significance. Conclusion : This study shows similar results to compare with previous CCRT reports and that CCRT is primary treatment of cervical cancer IIB. We may not improve remarkably survival with many chemotherapy cycles. But because of small population and retrospective study, further study of a large number of patients, prospective and long term follow up will be necessary to test the efficacy of the consolidation chemotherapy.

The feasibility study on continuous 7-day-a-week external beam irradiation in locally advanced cervical cancer: a report on acute toxicity

Purpose: To evaluate the feasibility and toxicity of continuous 7-day-a-week pelvic irradiation with no breaks between external beam irradiation and intracavitary applications. Material and methods: Between November 1998 and December 1999, 30 patients with FIGO Stage IIB or IIIB cervical cancer were treated with continuous 7-day-a-week pelvic irradiation, to the total Manchester point B dose of 40.0–57.6 Gy. The first 13 patients (group A) were applied a daily tumor dose of 1.6 Gy and the remaining 17 patients (group B)-10.8 Gy. One or two immediate brachytherapy applications (point A dose 10–20 Gy, each) were performed in 28 cases. Results: Two patients did not complete the irradiation due to apparent early progression of disease during the irradiation. Of the remaining 28 evaluable patients 11 (39%) completed treatment within the prescribed overall treatment time and 17 had unplanned treatment breaks. For the latter group overall treatment time ranged from 103 to 122% (mean 114%) and from 103 to 197% (mean 138%) of the planned treatment time for group A and B, respectively. The majority of patients experienced acute toxicity. Severe toxicity (EORTC/RTOG grade 3 and 4), predominantly gastrointestinal, occurred in 5 of the 13 patients in group A, and in 7 of 17 patients in group B. Conclusion: The studied regimen was accompanied by considerable toxicity, hindering delivery of irradiation within planned treatment time.