Long-term results and prognostic factors in patients with stage III–IVA squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy from a single institution study

• Published in: International journal of clinical oncology 2013-10, Vol.18 (5), p.916-921
• Main Authors: Kudaka, Wataru, Nagai, Yutaka, Toita, Takafumi, Inamine, Morihiko, Asato, Kozue, Nakamoto, Tomoko, Wakayama, Akihiko, Ooyama, Takuma, Tokura, Akemi, Murayama, Sadayuki, Aoki, Yoichi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brachytherapy; Cancer; Cancer Research; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Cells; Cervical cancer; Chemoradiotherapy - adverse effects; Chemotherapy; Cisplatin - administration & dosage; Cisplatin - adverse effects; Combined Modality Therapy; Disease-Free Survival; Drug-Related Side Effects and Adverse Reactions - pathology; Female; Humans; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Original Article; Prognosis; Radiotherapy Dosage; Risk Factors; Surgical Oncology; Treatment Outcome; Tumors; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-012-0457-x

Background We evaluated the longer-term efficacy and safety of concurrent chemoradiotherapy (CCRT) incorporating high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a lower cumulative radiotherapy (RT) protocol and analyzed prognostic risk factors for survival among patients with FIGO stage III–IVA squamous cell carcinoma (SCC) of the cervix. Patients and methods Ninety-nine patients with FIGO stage III–IVA SCC of the cervix between 1997 and 2008 were treated with CCRT using cisplatin 20 mg/m 2 for 5 days every 3 weeks or 40 mg/m 2 weekly. Acute and late toxicities were evaluated. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan–Meier method. The Cox proportional hazard model was used for multivariate analysis. Results Median age was 53.5 years. Median follow-up period was 58 months (range 6–170 months). Pathologically complete response was achieved in 93 patients (96.9 %). The 5-year OS and DFS were 72.0 and 69.3 %, respectively. The 5-year local and distant DFS were 83.0 and 75.1 %, respectively. Thirty-one patients (31.3 %) experienced recurrence. Multivariate analysis showed that tumor size and pretreatment hemoglobin level remained an independent risk factor for OS and DFS. Acute toxicity was moderate. In terms of late adverse effects, 2 patients (2.0 %) suffered from grade 4 late intestinal toxicity because of radiation enterocolitis, with both requiring intestinal surgery. Conclusions Our study demonstrates that the CCRT schedule in patients with FIGO stage III–IVA SCC is efficacious and safe. In addition, the assessment of tumor size and pretreatment anemia can provide valuable prognostic information.