Patterns of failure and treatment-related toxicity in advanced cervical cancer patients treated using extended field radiotherapy with curative intent.
OBJECTIVE
The purpose of this study was to evaluate the patterns of failure and overall survival (OS) and disease-free survival (DFS) rates in cervical cancer patients who had metastatic disease in common iliac or para-aortic lymph nodes and were treated with curative intent, using extended field radiotherapy (EFRT).


METHODS
This was a retrospective study involving 39 patients treated from January 1996 to June 2007, using EFRT with concurrent chemotherapy and intracavitary brachytherapy. EFRT consisted of 45 Gy in 1.8-Gy fractions. Radiation to involved nodes was boosted to a total dose of 50.4 to 54 Gy. Primary tumor radiation was boosted to a dose of 80 Gy using brachytherapy.


RESULTS
Overall, 30 patients (77%) have relapsed. The 5-year OS rate was 26% (95% confidence interval [CI], 11-44). The 5-year DFS rate was 19.4% (95% CI, 8-35). Only 3 patients (7.5%) experienced treatment failure exclusively within the treatment field, and 2 patients underwent salvage treatment. Grade 3 to 4 acute bone marrow and gastrointestinal toxicities were observed in 10 (26%) and 7 (18%) patients, respectively.


CONCLUSIONS
Concurrent chemotherapy and EFRT treatment was well tolerated. Most patients showed failure at multiple sites and outside the treatment field. Only 3/39 patients had failures exclusively within the treatment field, and 2 underwent salvage treatment.
Rajasooriyar
Chrishanthi
C
Division of Oncology, Teaching Hospital, Batticaloa, Sri Lanka. rchrishanthi@hotmail.com
Van Dyk
Sylvia
S
Bernshaw
David
D
Kondalsamy-Chennakesavan
Srinivas
S
Barkati
Maroie
M
Narayan
Kailash
K
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000528:radiation effects; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011832:Radiation Injuries / Q000150:complications*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*