title: Adjuvant radiochemotherapy in patients with locally advanced high-risk cervical cancer.
abstract: OBJECTIVE
  The aim of this retrospective study was to analyze the outcome of patients with locally advanced cervical carcinoma treated by adjuvant radiochemotherapy and to determine risk factors for local and distant relapse. Furthermore, acute and late effects of treatment were recorded.
  
  
  METHODS
  A total of 72 patients with FIGO stages I-III cervical carcinoma were treated by radical hysterectomy, pelvic lymphadenectomy, and postoperative radiochemotherapy. Only patients with positive pelvic lymph nodes, parametrial involvement, positive margins, or tumor bulk were eligible. Patients were irradiated with a standard pelvic field (50.4 Gy in 28 fractions). The majority of patients received platinum-based chemotherapy.
  
  
  RESULTS
  After a median follow-up of 37 months, estimated 1-, 2-, and 4-year disease-free survival (DFS) and overall survival (OS) rates were 89%, 80%, 68% and 95%, 88%, 76%, respectively. Nine of the 72 patients had pelvic recurrences including only 1 isolated local failure; 23 of the 72 patients presented with distant relapse. The majority of relapses occurred within the first 3 years after adjuvant treatment. The number of positive pelvic lymph nodes (> 1) was the strongest prognostic factor for DFS. Treatment was well tolerated with transient acute hematologic (~30%) and gastrointestinal (~30%) grade 3 toxicity. Small bowel obstruction (~6%) was the only important late sequelae.
  
  
  CONCLUSIONS
  Adjuvant radiochemotherapy in patients with advanced cervical cancer and several risk factors is highly effective to prevent local relapse. Future efforts to improve outcome should be placed on improvement of systemic control especially in subgroups with high-risk features for distant relapse. Combined treatment was well tolerated with moderate acute and late toxicity.
authors.affiliation: Department of Radiation Oncology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. frank.heinzelmann@med.uni-tuebingen.de
authors.forename: F
authors.initials: F
authors.lastname: Heinzelmann
authors.forename: G
authors.initials: G
authors.lastname: Henke
authors.forename: M
authors.initials: M
authors.lastname: von Grafenstein
authors.forename: N
authors.initials: N
authors.lastname: Weidner
authors.forename: F
authors.initials: F
authors.lastname: Paulsen
authors.forename: A
authors.initials: A
authors.lastname: Staebler
authors.forename: S
authors.initials: S
authors.lastname: Brucker
authors.forename: M
authors.initials: M
authors.lastname: Bamberg
authors.forename: M
authors.initials: M
authors.lastname: Weinmann
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000628:therapy*