title: Routine management of locally advanced cervical cancer with concurrent radiation and cisplatin. Five-year results.
abstract: BACKGROUND
  Globally, cervical cancer primarily affects socially disadvantaged women. Five randomized trials were the foundation for adopting cisplatin-based chemotherapy during radiation as the standard of care for high-risk patients after primary radical hysterectomy who require adjuvant radiation and for locally advanced patients treated with definitive radiation. These results were obtained in clinical trials performed in carefully prepared academic centers; hence, we sought to determine whether these results could be reproduced when patients were treated on an out-of-protocol basis.
  
  
  METHODS
  We reviewed the files of 294 patients with locally advanced cervical cancer who received radiation plus weekly cisplatin as routine management between 1999 to 2003, and analyzed treatment compliance, response rate, toxicity, and survival.
  
  
  RESULTS
  A total of 294 patients who received radiation and cisplatin were analyzed. Mean age was 43.8 years (range, 26-68 years). The majority of cases were squamous cell carcinoma (87.8%), and distribution according to International Federation of Gynecology and Obstetrics (FIGO) stage was as follows: IB2-IIA, 23%; IIB, 53.3%, and IIIB, 23%; there were only two IVA cases. Overall, 96% of patients completed external beam, and intracavitary therapy. The majority of patients (67%) received the planned six courses of weekly cisplatin. Complete responses were achieved in 243 (83%) patients, whereas 51 (17%) had either persistent (32 patients, 10.8%) or progressive (19 patients, 6.4%) disease. At median follow-up (28 months; range, 2-68 months), 36 patients (12.2%) have relapsed (locally 30.5, and systemically, 69.5%). The most common toxicities were hematologic and gastrointestinal, in the majority of cases considered mild-moderate. At median follow-up (28 months; range, 2-68 months), overall and progression-free survival are 76.5 and 67%, respectively.
  
  
  CONCLUSIONS
  Our results support use of chemoradiation with six weekly applications of cisplatin at 40 mg/m2 during external radiation for routine management of locally advanced cervical cancer.
authors.affiliation: Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. micuentalucely@yahoo.com
authors.forename: Lucely
authors.initials: L
authors.lastname: Cetina
authors.forename: Lesbia
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authors.lastname: Rivera
authors.forename: José
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authors.lastname: Hinojosa
authors.forename: Adela
authors.initials: A
authors.lastname: Poitevin
authors.forename: Jesús
authors.initials: J
authors.lastname: Uribe
authors.forename: Carlos
authors.initials: C
authors.lastname: López-Graniel
authors.forename: David
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authors.lastname: Cantú
authors.forename: Myrna
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authors.lastname: Candelaria
authors.forename: Jaime
authors.initials: J
authors.lastname: de la Garza
authors.forename: Alfonso
authors.initials: A
authors.lastname: Dueñas-González