title: Feasibility of extended-field irradiation and intracavitary brachytherapy combined with weekly cisplatin chemosensitization for IB2-IIIB cervical cancer with positive paraaortic or high common iliac lymph nodes: a retrospective review.
abstract: BACKGROUND
  The aim of this retrospective study was to investigate the feasibility of primary treatment with extended-field irradiation and weekly cisplatin (extended-field concurrent chemoradiotherapy, EFCCRT) as initial therapy in patients with International Federation of Gynecology and Obstetrics IB1 to IIIB cervical cancer with paraaortic or high common iliac lymph node metastases.
  
  
  METHODS
  Participants comprised patients with confirmed cervical cancer, showing paraaortic or high common iliac lymph node metastases on diagnostic imaging, treated with EFCCRT. Total external radiation doses were 50.4 Gy to the whole pelvis and 45.0 Gy to the lumbar paraaortic region. High-dose-rate intracavitary brachytherapy was performed to deliver a total dose of 18-24 Gy in 6-Gy fractions prescribed at point A. Weekly cisplatin (30-40 mg/m(2)) was given concurrently with radiotherapy.
  
  
  RESULTS
  Twenty-four patients were treated. Median follow-up interval was 34 months. The dose of cisplatin was 30 mg/m(2) in 2 cases, 35 mg/m(2) in 8 cases, and 40 mg/m(2) in 14 cases. Twenty-two cases (92 %) received more than 160 mg/m(2) cisplatin. Ten cases (42 %) experienced acute grade 3/4 hematological toxicity, and 9 cases (38 %) experienced acute grade 3 nonhematological toxicity. No case presented late grade 3/4 toxicity. Three-year progression-free and overall survival rates were 54 % and 72 %, respectively. Eleven cases recurred during follow-up. Sites of recurrence were within the irradiation field in 4 cases, outside the field in 6 cases, and in both fields in 1 case.
  
  
  CONCLUSIONS
  EFCCRT and high-dose-rate intracavitary brachytherapy for patients with paraaortic or high common iliac lymph node metastases from cervical cancer is feasible.
authors.affiliation: Division of Gynecology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan, s.kuji@scchr.jp.
authors.forename: Shiho
authors.initials: S
authors.lastname: Kuji
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hirashima
authors.forename: Satomi
authors.initials: S
authors.lastname: Komeda
authors.forename: Aki
authors.initials: A
authors.lastname: Tanaka
authors.forename: Masakazu
authors.initials: M
authors.lastname: Abe
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Takahashi
authors.forename: Munetaka
authors.initials: M
authors.lastname: Takekuma
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Asakura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Harada
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D002945:Cisplatin
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