title: Toxicity of concurrent chemoradiotherapy for locally advanced cervical cancer.
abstract: OBJECTIVE
  The analysis of acute and late toxicity of concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC) based on review of 120 patients treated in Centre of Oncology in Krakow between 2001 and 2007.
  
  
  METHODS
  Medium age of the patients was 52 years (43-66). Overall, 12 patients (10.0%) were in Stage IB2, 54 (45.0%) in Stage II, 43 (35.8%) in Stage III, and 11 (9.2%) in Stage IVA. Squamous cell carcinoma was present in 114 (95.0%) patients. Well-differentiated (grade 1) tumour was found in 39 (32.5%) patients, moderately differentiated (grade 2) in 41 (34.2%), and poorly differentiated (grade 3) in 40 (33.3%). Karnofsky performance status score was 70 in 72 (60.0%) patients, and 80-90 in 48 (40%). External radiation therapy was delivered with high-energy six to 15 MV photon beams using four-field brick technique. The total dose of 50 Gy was given in 25 fractions within five weeks using standard fractionation. Concurrently with external radiotherapy, six cycles of chemotherapy were administered to all the patients as an intravenous infusion of once-weekly cisplatin 40 mg/m2. On completion of external beam radiotherapy, low-dose rate brachytherapy with tandem and two colpostats was performed to deliver the dose of 40 Gy to point A in two 20 Gy insertions at weekly intervals.
  
  
  RESULTS
  Of the 120 patients in the investigated group, 78 (65%) were disease-free for five years. Symptoms of acute treatment-related toxicity grade 3 or 4 (WHO) occurred in 21.6% of patients including leucopoenia in 7.5%. anaemia in 5.0%, nausea and vomiting in 3.3%, diarrhea in 5.0%, and urinary tract infection in 0.8%. Full planned treatment (teleradiotherapy + chemotherapy + brachytherapy) completed 78.3% of the group; full planned radiotherapy without full chemotherapy completed 20% of the patients. Late treatment complications of grade 3 or 4 were observed in two (1.6%) patients (narrowing of large intestine requiring surgery and recto-vaginal fistula).
  
  
  CONCLUSIONS
  In patients with LACC treated with CCRT, the most frequent acute toxic effects include: haematological disorders (leucopoenia, anaemia), gastrointestinal disorders (nausea and vomiting, diarrhea), vulvo-vaginal disorders, and urinary tract infection. The most frequent late toxic effects included: rectal bleeding, bowel complications requiring surgery, stenosis or recto-vaginal fistula, and haematuria.
authors.forename: J
authors.initials: J
authors.lastname: Jakubowicz
authors.forename: P
authors.initials: P
authors.lastname: Blecharz
authors.forename: P
authors.initials: P
authors.lastname: Skotnicki
authors.forename: M
authors.initials: M
authors.lastname: Reinfuss
authors.forename: T
authors.initials: T
authors.lastname: Walasek
authors.forename: E
authors.initials: E
authors.lastname: Luczynska
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001918:Brachytherapy / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects*; D015331:Cohort Studies; D003108:Colonic Diseases / Q000209:etiology*; D003251:Constriction, Pathologic / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007970:Leukopenia / Q000209:etiology*; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D012006:Rectovaginal Fistula / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D014839:Vomiting / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin