title: Concurrent chemoradiotherapy incorporating high-dose rate brachytherapy for locally advanced cervical carcinoma: survival outcomes, patterns of failure, and prognostic factors.
abstract: BACKGROUND
  This is a retrospective study evaluating the survival outcomes, patterns of failure, and prognostic factors of chemoradiotherapy incorporating high-dose rate brachytherapy in the treatment of locally advanced cervical cancer.
  
  
  METHODS
  A review of 120 consecutive patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stages IB2 to IVA cervical cancer treated with concurrent cisplatin-based chemoradiotherapy between April 1999 and January 2005. Overall (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method.
  
  
  RESULTS
  The 5-year OS and DFS rates were, respectively, 65.0% (35.0% IB2, 65.7% IIA-B, 71.0% IIIA-B, and 40.0% IVA) and 57.3% (30.0% IB2, 58.2% IIA-B, 64.0% IIIA-B, and 40.0% IVA). Most patients had squamous cell carcinoma (89.2%) and belonged to FIGO stages IIB (40.8%) and IIIB (30.8%). All but 4 patients completed the planned radiotherapy regimen. There were 48 documented recurrences, of which 13 were locoregional only, 26 were distant only, and 9 were both sites. Five patients (4.2%) experienced late grade 3 to 4 gastrointestinal toxicity. On multivariate analysis, a preradiotherapy hemoglobin level of less than 10 g/dL and tumor size of 4 cm or greater or bulky on computed tomography were independently significant variables for OS, whereas a nadir hemoglobin level of less than 10 g/dL and presence of radiologically enlarged pelvic or paraaortic lymph nodes were independently significant variables for DFS.
  
  
  CONCLUSIONS
  We conclude that this regimen is efficacious and feasible, but the safety profile about concurrent administration of high-dose rate brachytherapy and chemotherapy should be studied further. Finally, for cervical cancer patients selected for nonsurgical treatment, radiological assessment of tumor size and lymph node status can provide valuable prognostic information over and above FIGO staging alone.
authors.affiliation: Department of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610, Republic of Singapore. jonteh@gmail.com
authors.forename: Jonathan
authors.initials: J
authors.lastname: Teh
authors.forename: Swee Peng
authors.initials: SP
authors.lastname: Yap
authors.forename: Ivan
authors.initials: I
authors.lastname: Tham
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sethi
authors.forename: Eu Jin
authors.initials: EJ
authors.lastname: Chua
authors.forename: Richard
authors.initials: R
authors.lastname: Yeo
authors.forename: Tew Hong
authors.initials: TH
authors.lastname: Ho
authors.forename: Eng Hseon
authors.initials: EH
authors.lastname: Tay
authors.forename: Yin Nin
authors.initials: YN
authors.lastname: Chia
authors.forename: Lay Tin
authors.initials: LT
authors.lastname: Soh
authors.forename: Hoon Seng
authors.initials: HS
authors.lastname: Khoo-Tan
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*