title: The effect of carbogen breathing and nicotinamide added to standard (chemo)radiation treatment of advanced cervical cancer in Indonesia.
abstract: OBJECTIVE
  Chemoradiation is the standard therapy for advanced stages of cervical cancer. In developing countries, where 80% of cervical cancers occur, this is not always available. Carbogen breathing and oral nicotinamide (CON) therapy, aimed at overcoming tumor hypoxia, has shown to improve treatment efficacy in some epithelial tumors. This study investigates the effect of CON during (chemo)radiation of advanced stages of cervical cancer on overall survival, local and regional control, and toxicity.
  
  
  METHODS
  From December 2006 to February 2010, 139 patients with stage IB2 to IVA cervical cancer were nonrandomly assigned to receive radiotherapy (RT) or chemoradiation (CRT) with or without CON. Differences in overall survival, local and regional control after 1 year, and toxicity were assessed in 113 evaluable patients. Thirty-two patients received RT, 16 received CRT, 45 received CON-RT, and 20 received CON-CRT.
  
  
  RESULTS
  The CON-RT and RT groups contained significantly more patients with a poor performance status and IIIB and IVA tumors. Despite these differences in baseline characteristics, overall survival and local and regional control at 1 year were not significantly different (P = 0.10 and P = 0.19, respectively). Toxicity scores also did not differ (P = 0.60 and P = 0.73 for acute and late toxicity).
  
  
  CONCLUSIONS
  Addition of CON to standard (chemo)radiation gives comparable survival and control rates. The effect of CON might be underestimated due to differences in baseline characteristics. Because chemotherapy cannot always be (completely) administered in low-resource settings, CON could be a worthy substitute. The CON treatment is feasible and safe.
authors.affiliation: *Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands; †Department of Radiotherapy, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; and ‡Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: van Weelden
authors.forename: Sri Mutya
authors.initials: SM
authors.lastname: Sekarutami
authors.forename: Ruud L M
authors.initials: RL
authors.lastname: Bekkers
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Kaanders
authors.forename: Jan
authors.initials: J
authors.lastname: Bussink
authors.forename: Soehartati
authors.initials: S
authors.lastname: Gondhowiardjo
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Leer
authors.forename: Paul N
authors.initials: PN
authors.lastname: Span
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000008:administration & dosage*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007214:Indonesia; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000008:administration & dosage*; D010100:Oxygen / Q000008:administration & dosage*; D011379:Prognosis; D011446:Prospective Studies; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage; D012138:Respiratory Therapy; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014803:Vitamin B Complex / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D014803:Vitamin B Complex; D002245:Carbon Dioxide; D009536:Niacinamide; C011700:carbogen; D002945:Cisplatin; D010100:Oxygen