title: Survival and Toxicity Following Chemoradiation for Carcinoma of the Cervix - Impact of Multiple-phase Treatment and Shielding.
abstract: OBJECTIVE
  We report on outcomes and significant grade 3-4 late toxicities between January 1999 and October 2006 following introduction of multi-phase treatment and effect of shielding in treatment of cervical cancer with concurrent chemoradiation.
  
  
  METHODS
  Radiotherapy dose by phase, recurrence, survival and toxicity data was collated by a retrospective review of clinical notes. Shielding information was retrieved from original planning films.
  
  
  RESULTS
  3-year survival for stages I, II and III disease were 89%,76% and 51% respectively. Local pelvic failure was 9%. Overall significant late toxicity (SLT) rate was 13%, with lower rates for post-operative treatment than primary chemoradiation (4% vs. 16%). SLT with single phase treatment was 29% versus 12% following multiphase EBRT and 16% when <2 areas were shielded versus 6% with ≥3 shielded areas (p=0.01).
  
  
  CONCLUSIONS
  Shielding and multi-phase treatment not only reduce dose to organs at-risk but can also reduce late toxicity without compromising local control or survival.
authors.affiliation: Hall Edwards Radiotherapy Research group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, U.K. drsundusyahya@yahoo.co.uk.
authors.forename: Sundus
authors.initials: S
authors.lastname: Yahya
authors.affiliation: Christie Hospital, Manchester, U.K.
authors.forename: Lubna
authors.initials: L
authors.lastname: Bhatt
authors.affiliation: Christie Hospital, Manchester, U.K.
authors.forename: Margaret
authors.initials: M
authors.lastname: King
authors.affiliation: Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, The University of Birmingham, Birmingham, U.K.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pirrie
authors.affiliation: Hall Edwards Radiotherapy Research group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, U.K.
authors.forename: Ruth
authors.initials: R
authors.lastname: Wyatt
authors.affiliation: Hall Edwards Radiotherapy Research group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, U.K.
authors.forename: Muhammed Suhail
authors.initials: MS
authors.lastname: Anwar
authors.affiliation: Hall Edwards Radiotherapy Research group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, U.K.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Modir
authors.affiliation: Hall Edwards Radiotherapy Research group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, U.K.
authors.forename: Indrajit
authors.initials: I
authors.lastname: Fernando
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D052776:Female Urogenital Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011835:Radiation Protection / Q000295:instrumentation*; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
keywords: Brachytherapy; cervical cancer; radiotherapy; shielding; toxicity