title: Results of concomitant chemoradiation for cervical cancer using high dose rate intracavitary brachytherapy: study of JROSG (Japan Radiation Oncology Study Group).
abstract: The purpose of this study was to clarify outcome for concurrent chemoradiation (CT-RT) in locally advanced cervix cancer in Japan. This is a non-randomized retrospective analysis of 226 patients treated with definitive CT-RT or radiotherapy alone (RT alone) in nine institutions between 2001 and 2003. External irradiation consisted of whole pelvic irradiation and pelvic side wall boost irradiation, using a central shield during the latter half of the treatment with the anteroposterior parallel opposing technique. The external beam irradiation was performed with 1.8 or 2 Gy per fraction. High-dose-rate intracavitary brachytherapy (HDR) was performed in all cases. In chemotherapy, platinum based drugs were used alone or in combination with other drugs such as 5FU. Grade of late complications was scaled retrospectively with CTCv2.0. Overall survival rate at 50 months of stage Ib, II and III, IV was 82% and 66% in CR-RT and 81% and 43% in R alone, respectively. Disease-free survival rate at 50 months of stage Ib, II and III, IV was 74% and 59% in CR-RT and 76% and 52% in R alone, respectively. There was no significant difference between CT-RT and RT for overall survival and disease free survival. Univariate analysis suggested that loco-regional control was better with CT-RT, but multivariate analysis could not confirm this finding. Compared to RT alone, CT-RT caused significantly more acute and late complications. Thus, late complication (grade 3-4) free survival rate at 50 month was 69% for CT-RT and 86% for RT alone (p<0.01). The therapeutic window with concomitant radiochemotherapy and HDR brachytherapy may be narrow, necessitating a close control of dose volume parameters and adherence to systems for dose prescription.
authors.affiliation: Department of Radiology, Sapporo Medical University, School of Medicine, Sapporo, Japan. sakatako@sapmed.ac.jp
authors.forename: Koh-ichi
authors.initials: K
authors.lastname: Sakata
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Shingo
authors.initials: S
authors.lastname: Katoh
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ohno
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kataoka
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Yuuko
authors.initials: Y
authors.lastname: Kaneyasu
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
authors.forename: Yoko
authors.initials: Y
authors.lastname: Harima
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015182:Lymphatic Irradiation; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D017663:Peplomycin / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D018906:Antineoplastic Agents, Alkylating; D009944:Organoplatinum Compounds; D016685:Mitomycin; D017663:Peplomycin; D014750:Vincristine; D005472:Fluorouracil