title: Long-term Outcomes and Late Effects of Definitive Chemoradiotherapy in Patients with Cervical Cancer in Nova Scotia.
abstract: OBJECTIVE
  To determine the long-term oncologic outcomes and toxicity of patients treated with definitive chemo-radiotherapy for cervical cancer.
  
  
  METHODS
  The study period was January 1, 2000 to December 31, 2009. All patients diagnosed with cervical cancer who received curative-intent chemoradiotherapy were included. Patients were excluded if they resided out of the province, received surgery as an initial treatment, or were treated with palliative intent. A retrospective chart review was performed.
  
  
  RESULTS
  Four hundred and eighty-six patients were diagnosed with cervical cancer; 190 met eligibility criteria. Median follow-up for all patients was 3.2 years (interquartile range 1.1-5.6 years). Clinical stage was FIGO IIB or higher in 139 of 190 patients (73.2%). One hundred and fifty-eight (82.7%) received concurrent cisplatin chemotherapy (mean # cycles = 4.8). The most common external beam radiotherapy (EBRT) dose/fractionation schedule was 45 Gray (Gy) in 25 fractions (149 pts, 78.0%). One hundred and thirty-six (71.2%) received low-dose-rate (LDR) brachytherapy (BT: most common dose = 35 Gy). High-dose-rate (HDR) BT was implemented in 2008; the most common HDR dose was 24 Gy in 8 fractions over five days.  Five-year overall survival (OS) and progression-free survival (PFS) were 69.4% and 61.4%, respectively. OS and PFS were significantly higher in patients who received chemotherapy vs. radiotherapy alone. For those receiving HDR-BT, there was a significantly higher OS, but not PFS. The rate of late RTOG Grade 3/4 toxicity at five years was 23.3% (gastrointestinal - 26 events, 13% of patients; genitourinary - 13 events, 8% of patients). Fourteen patients had Grade 3 radiation proctitis as the only late toxicity. EBRT dose above 45 Gy was the only factor associated with late toxicity on multivariate analysis.
  
  
  CONCLUSIONS
  Outcomes of patients treated with chemoradiotherapy for cervical cancer are in keeping with those reported in other series. Chemotherapy improved OS and PFS. External beam radiotherapy dose above 45 Gy was the only predictor of late toxicity.
authors.affiliation: Medical student, Dalhousie University.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Royal-Preyra
authors.affiliation: Department of Radiation Oncology, Dalhousie University.
authors.forename: David
authors.initials: D
authors.lastname: Bowes
authors.affiliation: Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bahl
authors.affiliation: Department of Radiation Oncology, Dalhousie University.
authors.forename: Paul
authors.initials: P
authors.lastname: Joseph
authors.affiliation: Department of Radiation Oncology, Dalhousie University.
authors.forename: Maureen
authors.initials: M
authors.lastname: Nolan
authors.affiliation: Department of Radiation Oncology, Dalhousie University.
authors.forename: Hylkije
authors.initials: H
authors.lastname: Ymeri
authors.affiliation: Division of Gynecology Oncology, Dalhousie University.
authors.forename: James
authors.initials: J
authors.lastname: Bentley
authors.affiliation: Nova Scotia Cancer Centre, Nova Scotia Health Authority, Dalhousie University.
authors.forename: Nikhilesh
authors.initials: N
authors.lastname: Patil
keywords: brachytherapy; cervical cancer; chemotherapy; toxicity