title: Extended-field irradiation and intracavitary brachytherapy combined with cisplatin and amifostine for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of arm II of Radiation Therapy Oncology Group (RTOG) 0116.
abstract: OBJECTIVE
  Radiation Therapy Oncology Group (RTOG) 0116 was designed to test the ability of amifostine (Ethyol; MedImmune LLC, Gaithersburg, MD), a cytoprotective agent, to reduce the acute toxicity of combined therapy with extended-field irradiation, brachytherapy, and cisplatin chemotherapy in patients with cervical cancer with para-aortic or high common iliac disease. This report presents the results of part 2.
  
  
  METHODS
  Radiation Therapy Oncology Group 0116 was a 2-part trial. Part 1 delivered extended-field irradiation, brachytherapy, and cisplatin; part 2 added amifostine and required 16 evaluable patients to assess an improved toxicity profile. Eligibility included evidence for high common iliac or para-aortic metastasis. Patients were treated for a total dose of 45 Gy in 25 fractions with intracavitary irradiation. Intensity-modulated radiation therapy was not allowed. The final point A dose was 85 Gy low-dose rate equivalent. High-dose rate techniques were allowed. The positive para-aortic and iliac nodes were to be boosted to 54 to 59.4 Gy. Amifostine at 500 mg was to be delivered with every fraction of radiotherapy.
  
  
  RESULTS
  The study opened on August 1, 2001, and closed March 3, 2007, after accruing 45 patients, 18 for the second part with amifostine. This analysis reports the primary end point for the patients entered on part 2 of the study. Three patients were excluded, one was ineligible, and 2 withdrew. The median follow-up was 22.9 months (range, 6.5-45.4 months). The median dose of amifostine delivered was 5000 mg (range, 500-13,500 mg). Thirteen patients (87%) experienced an acute grade 3/4 toxicity (excluding grade 3 leukopenia). This compared to an 81% rate in part 1 of the trial. The estimated median survival was 34.8 months with a 20% late grade 3/4 toxicity rate.
  
  
  CONCLUSIONS
  Amifostine, as delivered in this study, did not reduce acute toxicity in this patient population.
authors: The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA. wsmall@nmff.org
authors: William
authors: W
authors: Small
authors: Kathryn
authors: K
authors: Winter
authors: Charles
authors: C
authors: Levenback
authors: Revathy
authors: R
authors: Iyer
authors: Sharon R
authors: SR
authors: Hymes
authors: Anuja
authors: A
authors: Jhingran
authors: David
authors: D
authors: Gaffney
authors: Beth
authors: B
authors: Erickson
authors: Kathy
authors: K
authors: Greven
mesh_terms: D000328:Adult; D000368:Aged; D004999:Amifostine / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D011837:Radiation-Protective Agents; D004999:Amifostine; D002945:Cisplatin