title: Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix.
abstract: OBJECTIVE
  To assess the acute tolerance of delivering concurrent cisplatin and extended field radiotherapy (EFRT) using intensity-modulated radiotherapy technique (IMRT) for cancer of the cervix.
  
  
  METHODS
  All patients receiving definitive treatment for cervical cancer were treated with EFRT using IMRT technique and concurrent cisplatin. The treatment volume included the cervix, uterus, parametria, presacral space, upper vagina, pelvic, common iliac, and paraaortic nodes to the top of L1. All regions received 45 Gy (25 fractions) with a simultaneous boost to involved nodes (55 Gy/25 fractions). Patients were assessed weekly for toxicity and response.
  
  
  RESULTS
  Twenty-two consecutive patients underwent treatment. All patients completed the prescribed course of EFRT. Median treatment length was 39.5 days (range 36-53). Treatment breaks of 2 and 3 days were required for bone marrow toxicity in 2 patients. The final week of chemotherapy was held in 2 patients because of neutropenia. No patient suffered acute or subacute grade 3 or 4 GI or GU toxicity.
  
  
  CONCLUSIONS
  In this clinical study, an IMRT technique was used to successfully deliver EFRT with concurrent chemosensitization for cervical cancer. The technique was associated with an acceptable acute toxicity without significant treatment protraction. This new role for IMRT merits further evaluation with larger patient numbers and longer follow-up.
authors.affiliation: Department of Radiation Oncology, UPMC Cancer Pavillon (POB II), 5150 Centre Avenue, 5th Floor, Room 544B, Pittsburgh, PA 15232, USA. gersztenk@upmc.edu
authors.forename: Kristina
authors.initials: K
authors.lastname: Gerszten
authors.forename: Kelly
authors.initials: K
authors.lastname: Colonello
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Ron J
authors.initials: RJ
authors.lastname: Lalonde
authors.forename: Issa D
authors.initials: ID
authors.lastname: Fitian
authors.forename: John T
authors.initials: JT
authors.lastname: Comerci
authors.forename: Raj N
authors.initials: RN
authors.lastname: Selvaraj
authors.forename: John M
authors.initials: JM
authors.lastname: Varlotto
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004333:Drug Administration Routes; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin