A multi-institutional observational study on the effects of three-dimensional radiotherapy and weekly 40-mg/m2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors

Abstract

Background The aim of this study was to evaluate the effects of treatment with both three-dimensional radiotherapy (3DRT) and weekly 40-mg/m 2 cisplatin on postoperative uterine cervical cancer patients with high-risk prognostic factors. Methods We conducted a retrospective multi-institutional chart review of postoperative uterine cervical cancer patients with high-risk prognostic factors who had been treated with both 3DRT and weekly 40-mg/m 2 cisplatin from 2007 to 2012. Each participating hospital provided detailed information regarding patient characteristics, treatment outcomes, and treatment complications. Results The eligible 96 patients were analyzed. The median follow-up period was 61 months. The 3-year relapse-free survival, overall survival (OS), and locoregional relapse-free survival (LRFS) rates were 76%, 90%, and 88%, respectively. In multivariate analysis, the histological finding of either adenocarcinoma or adenosquamous carcinoma was a significant risk factor for both OS and LRFS. The percentage of patients with grade ≥ 3 acute hematologic toxicity, acute lower gastrointestinal toxicity (GIT), and late lower GIT were 45%, 19%, and 17%, respectively. Conclusions The outcomes of concurrent chemoradiotherapy (CCRT) using weekly 40-mg/m 2 cisplatin are similar to those in the previous studies that used several chemotherapy regimens. However, postoperative CCRT using 3DRT had a high level of late GIT.

Clinical Implication of Simultaneous Intensity-modulated Radiotherapy Boost to Tumor Bed for Cervical Cancer with Full-thickness Stromal Invasion

“…For high-risk patients, the OS, PFS, and p-PFS were 50.8%, 67.8%, and 71.6%, respectively, in the non-boost group. These results were consistent with previously published reports of OS and PFS, 27 , 28 and were significantly better than the 5-year OS, PFS, and p-PFS of patients without tumor bed boost.…”

Phase 1 trial of nelfinavir added to standard cisplatin chemotherapy with concurrent pelvic radiation for locally advanced cervical cancer

“…The most common toxicities reported were low‐grade hematologic (anemia, leukopenia, or neutropenia) and gastrointestinal (nausea, vomiting, or diarrhea) toxicities. Notably, hematologic and gastrointestinal toxicity are the most commonly reported adverse events among patients receiving standard‐of‐care, cisplatin‐based CRT, with 66% of patients experiencing some level of leukopenia (23% of which were grade 3 or 4) and 72% experiencing gastrointestinal events (12% of which were grade 3 or 4) 5,32 . In the current study, high‐grade (grade 3 or 4) anemia was experienced by 9% of patients, high‐grade leukopenia was experienced by 27%, and high‐grade neutropenia was experienced by 9%.…”

Age-Dependent Hematologic Toxicity Profiles and Prognostic Serologic Markers in Postoperative Radiochemotherapy Treatment for Uterine Cervical Cancer

“…The use of 3-dimensional RT techniques using concurrent weekly cisplatin 40 mg/m 2 resulted in high rates of grade ≥3 acute hematologic toxicity and 19% acute lower gastrointestinal toxicity, but comparable 3-year OS of 90% and LC of 88%. 21 The application of advanced and widespread pelvic IMRT techniques as used in our study, however, can lower the rates of hematologic toxicity without diminishing the oncologic outcome. The RTOG 0418 trial of Klopp et al 44 investigated the impact of the RT dose on the hematopoietic stem cell compartment and found an improved bone marrow sparing in a group of women who received postoperative RCHT and radiotherapy for cervical (n = 40) and endometrial cancer (n = 43) to be significantly associated with lower rates of hematotoxicity.…”

“… 18 , 19 The addition of postoperative concurrent chemotherapy showed significantly improved progression-free and OS in the adjuvant high-risk setting in the Gynecologic Oncology Group (GOG 109) trial, and concurrent cisplatin-based schemes are currently the standard of care as it has the least toxicity among various chemotherapy regimens. 19 – 21 Nevertheless, there is evidence that only patients with multiple lymph nodes or histologic subtype of squamous cell carcinoma may benefit from adjuvant chemotherapy. 12 , 22 The assessment of risk factors remains controversial and heterogeneous, and the STARS trial 23 further questions the sequence of the optimal chemotherapy administration, preferring a sequential application more than concurrent regimens.…”