title: Chemoradiation therapy for cervical cancer: toxicity of concurrent weekly cisplatin.
abstract: OBJECTIVE
  To retrospectively evaluate the toxicity of concurrent weekly cisplatin and radiation therapy (RT) for locally advanced cervical cancer.
  
  
  METHODS
  Between April 2001 and December 2004, 21 consecutive previously untreated patients with locally advanced cervical cancer were treated with concurrent chemoradiation therapy (CCRT) at the Tokushima University Hospital. Clinical stages were II: 5, III: 15, IVA: 1. External beam radiation therapy (EBRT) was delivered with 10 MV X-rays, 2 Gy fraction per day; total dose to the whole pelvis was 50 Gy. Iridium-192 high-dose-rate (HDR) intracavitary radiation therapy was performed with 10-30 Gy (median, 24 Gy) targeted at point A. Concurrent chemotherapy consisted of cisplatin, administered weekly at a dose of 40 mg/m2 for patients who were younger than 65 years and 30 mg/m2 for those 65 years or over. A maximum single dose of cisplatin, up to 70 mg/body, was administered in 5 cycles during EBRT.
  
  
  RESULTS
  A total of 86 cycles of cisplatin were administered to the 21 patients, with a median of 4 cycles (range, 2-5). Severe hematological toxicity occurred in 18 patients (86%), including grade 3 in 17 patients (81%) and grade 4 in one patient (4.8%). Moderate or severe gastrointestinal toxicity occurred in 11 patients (52%), including grade 2 in 10 patients (48%) and grade 3 in one patient (4.8%). The grades of hematological toxicity were significantly greater in the 40 mg/m2 group than in the 30 mg/m2 group. All of the patients who were administered 40 mg/m2 of cisplatin developed grade 3 or greater hematological toxicity, including one patient with grade 4 toxicity. In the 30 mg/m2 group, 3 of 10 patients developed less than grade 3 toxicity, and all patients completed radiation therapy without interruption.
  
  
  CONCLUSIONS
  The incidence of severe acute hematological toxicity was significantly higher in this study than in previously reported randomized controlled trials (RCTs), especially in the group of 40 mg/m2 cisplatin. A dose of 30 mg/m2 of cisplatin was considered to be feasible in weekly cisplatin and radiation therapy.
authors.affiliation: Departments of Radiology, Tokushima University School of Medicine, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ikushima
authors.forename: Kyousuke
authors.initials: K
authors.lastname: Osaki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Furutani
authors.forename: Kyou
authors.initials: K
authors.lastname: Yamashita
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawanaka
authors.forename: Yoshiomi
authors.initials: Y
authors.lastname: Kishida
authors.forename: Seiji
authors.initials: S
authors.lastname: Iwamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takegawa
authors.forename: Takaharu
authors.initials: T
authors.lastname: Kudoh
authors.forename: Hiromu
authors.initials: H
authors.lastname: Nishitani
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin