title: Adjuvant Chemotherapy in Locally Advanced Cervical Cancer After Treatment with Concomitant Chemoradiotherapy--Room for Improvement?
abstract: BACKGROUND
  The standard treatment for locally advanced cervical cancer (LACC) is concomitant chemoradiotherapy. In the majority of patients with LACC after properly executed concomitant chemoradiotherapy local control of the disease is achieved, and consequently distant relapse becomes the main cause of death for these patients. In an attempt to improve the outcome of patients with LACC, we designed a regimen of concomitant chemobrachyradiotherapy with cisplatin and ifosfamide followed by consolidation chemotherapy.
  
  
  METHODS
  Between 1999 and 2012, 118 patients diagnosed with LACC, The International Federation of Gynecology and Obstetrics (FIGO) stages IB2-IVA, regardless of histology, were treated with concomitant chemobrachyradiotherapy and consolidation chemotherapy at our Institution. Chemotherapy consisted of two cycles of cisplatin and ifosfamide applied concomitantly with two intracavitary low-dose rate brachytherapy applications, and of four cycles of the same drug combination as an adjuvant/consolidation part of the treatment. The primary outcome in this analysis was distant disease-specific survival.
  
  
  RESULTS
  A total of 18 patients had documented relapse of cervical cancer, with only three local recurrences observed; 15 patients developed only distant recurrence, and one patient developed both local and distant recurrence. The distant disease-specific survival after a median follow-up of 96 months was 86.4%.
  
  
  CONCLUSIONS
  Consolidation or adjuvant chemotherapy that follows concomitant chemoradiotherapy has a potential role in further improving control of the disease, especially distant control of the disease.
authors.affiliation: Clinic for Oncology and Radiotherapy, University Hospital Split, Split, Croatia.
authors.forename: Tihana Boraska
authors.initials: TB
authors.lastname: Jelavić
authors.affiliation: Clinic for Oncology and Radiotherapy, University Hospital Split, Split, Croatia.
authors.forename: Branka Petrić
authors.initials: BP
authors.lastname: Miše
authors.affiliation: Clinic for Oncology and Radiotherapy, University Hospital Split, Split, Croatia.
authors.forename: Ante
authors.initials: A
authors.lastname: Strikic
authors.affiliation: Clinic for Oncology and Radiotherapy, University Hospital Split, Split, Croatia.
authors.forename: Marija
authors.initials: M
authors.lastname: Ban
authors.affiliation: Clinic for Oncology and Radiotherapy, University Hospital Split, Split, Croatia edo.vrdoljak@gmail.com.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vrdoljak
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods; D059248:Chemoradiotherapy / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000628:therapy
chemical_list: D002945:Cisplatin; D007069:Ifosfamide
keywords: Cervical cancer; adjuvant chemotherapy; cisplatin; concomitant chemoradiotherapy; ifosfamide