title: Clinical efficacy of alternating chemoradiotherapy by conformal radiotherapy combined with intracavitary brachytherapy for high-risk cervical cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the outcome of alternating chemoradiotherapy in patients with high-risk cervical cancer.
  
  
  METHODS
  We performed definitive alternating chemoradiotherapy in cervical cancer patients with at least one high-risk factor such as International Federation of Gynecology and Obstetrics III or IVA disease, primary tumor diameter ≥50 mm, positive pelvic node, and positive para-aortic node. Our chemoradiotherapy protocol was as follows: (i) alternating chemoradiotherapy with 5-fluorouracil and nedaplatin; (ii) whole pelvic radiotherapy with the dynamic conformal technique combined with intracavitary brachytherapy; (iii) prophylactic irradiation to the para-aortic region for International Federation of Gynecology and Obstetrics III/IVA or positive pelvic node and full-dose radiotherapy for positive para-aortic node. Between 1998 and 2010, 121 patients were treated with this protocol.
  
  
  RESULTS
  The median follow-up period was 53.7 months (7.6-162.2). International Federation of Gynecology and Obstetrics stages were IB; (9.1%), IIA; 6 (5.0%), IIB; 53 (43.8%), IIIA; 7 (5.8%), IIIB; 37 (30.6%) and IVA; 7 (5.8%), respectively. Nodal involvement was reported in 77 patients (63.6%) at the pelvis and 25 (20.7%) at the para-aortic region. The 5-year overall survival and progression-free survival rates were 80.0 and 63.4%, respectively. Regarding Grade ≥3 late toxicities, three patients developed urinary and three developed intestinal toxicities. We encountered no treatment-related death.
  
  
  CONCLUSIONS
  The clinical results of our alternating chemoradiotherapy protocol for high-risk cervical cancer are promising.
authors.affiliation: Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto.
authors.forename: Kimiko
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi 109103@aichi-cc.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi.
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Radiology, Aichi Medical University Hospital, Aichi.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Ohshima
authors.affiliation: Department of Radiology, Nagoya University Hospital, Aichi.
authors.forename: Junji
authors.initials: J
authors.lastname: Ito
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tachibana
authors.affiliation: Department of Gynecology, Aichi Cancer Center Hospital, Aichi.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Department of Radiology, Hyogo Ion Beam Medical Center, Hyogo, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D009944:Organoplatinum Compounds; C053989:nedaplatin; D005472:Fluorouracil
keywords: chemo-gynecology; gynecol-radoncol; radiation oncology