title: Chemoradiation in locally advanced cervical carcinoma: an analysis of cisplatin dosing and other clinical prognostic factors.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of number of chemotherapy cycles and other clinical and pathologic factors on progression-free (PFS) and overall survival (OS) in patients with newly diagnosed cervical cancer.
  
  
  METHODS
  We identified 118 patients with locally advanced cervical cancer (stages IB2-IVA) treated with combination weekly cisplatin (40 mg/m(2)) and radiation therapy (RT) between 2003 and 2007. Kaplan-Meier and Cox proportional hazard models were utilized to evaluate PFS and OS for associations with number of chemotherapy cycles and other factors.
  
  
  RESULTS
  The majority of patients had stage IB2 or II disease (70%), squamous histology (91%), and size <6 cm (65%). Median RT duration was 50 days and 95% received brachytherapy. Thirty percent of patients completed <6 cycles of chemotherapy, and estimated PFS and OS were 63% and 75%, respectively. In multivariate analyses, the number of chemotherapy cycles was independently predictive of PFS and OS. Patients who received <6 cycles of cisplatin had a worse PFS (HR 2.65; 95% CI 1.35-5.17; p=0.0045) and OS (HR 4.47; 95% CI 1.83-10.9; p=0.001). Advanced stage, longer time to RT completion, and absence of brachytherapy were also associated with decreased OS and PFS (p<0.05). Similar results were found when analysis was conducted using a breakpoint of at least five but not less than five chemotherapy cycles. Higher grade was associated with decreased PFS (p=0.03) but not OS. Age, race, BMI, tumor size, smoking, histology, and IMRT were not statistically significant for OS or PFS.
  
  
  CONCLUSIONS
  Aggressive supportive care to minimize missed chemotherapy treatments may improve survival after chemoradiation.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, 4th Floor Maternity, St. Louis, MO 63110, USA. nugente@wudosis.wustl.edu
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Nugent
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Case
authors.forename: John T
authors.initials: JT
authors.lastname: Hoff
authors.forename: Israel
authors.initials: I
authors.lastname: Zighelboim
authors.forename: Lorri L
authors.initials: LL
authors.lastname: DeWitt
authors.forename: Kim
authors.initials: K
authors.lastname: Trinkhaus
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Janet S
authors.initials: JS
authors.lastname: Rader
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D016190:Carboplatin