title: Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer.
abstract: OBJECTIVE
  We identified the predictive factors for locoregional failure after definitive chemoradiation in patients with locally advanced cervical cancer.
  
  
  METHODS
  Altogether, 397 patients with locally advanced cervical cancer (stage IB2-IVA) were treated with definitive chemoradiation between June 2001 and February 2010. Platinum-based concurrent chemotherapy was given to all patients with median radiation dose of external beam radiotherapy 50.4 Gy in 28 fractions and intracavitary radiotherapy 30 Gy in 6 fractions. Competing risk regression analysis was used to reveal the predictive factors for locoregional failure.
  
  
  RESULTS
  During the median follow-up of 7.2 years, locoregional failure occurred in 51 (12.9%) patients. The estimated 3-year rate of locoregional control was 89%, whereas the overall survival rate was 82%. After univariate and multivariate analyses, large tumor size (>5 cm), young age (≤40 years), nonsquamous histology, positive lymph node on magnetic resonance imaging, and advanced stage (III-IV) were identified as risk factors for locoregional failure (P = 0.003, P = 0.075, P = 0.005, P = 0.055, and P < 0.001, respectively). After risk grouping according to the coefficients from the multivariate model, we identified a high-risk group for locoregional failure after treatment with definitive chemoradiation as follows: (1) tumor size larger than 5 cm, and at least 1 other risk factor or (2) tumor size 5 cm or less, and at least 3 other risk factors. The cumulated estimated 3-year rate of locoregional failure of the high-risk group was 26%, which was significantly higher than that of the low-risk group (7%, P < 0.001). The 3-year overall survival rates of the 2 groups were also significantly different (57% vs 86%, P < 0.001).
  
  
  CONCLUSIONS
  Large tumor size (>5 cm), young age (≤40 years), nonsquamous histology, positive lymph node on magnetic resonance imaging, and advanced stage are all risk factors for locoregional failure after definitive platinum-based chemoradiation in patients with locally advanced cervical cancer. In the high-risk group, further clinical trials are warranted to improve the locoregional control rate.
authors.affiliation: *Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do; †Department of Gynecologic Oncology and Minimally Invasive Surgery, CHA Gangnam Medical Center, CHA University, Seoul; and ‡Gynecologic Cancer Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea.
authors.forename: Hyo Sook
authors.initials: HS
authors.lastname: Bae
authors.forename: Yeon-Joo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Myong Cheol
authors.initials: MC
authors.lastname: Lim
authors.forename: Sang-Soo
authors.initials: SS
authors.lastname: Seo
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
authors.forename: Sokbom
authors.initials: S
authors.lastname: Kang
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy / Q000401:mortality*; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D015996:Survival Rate; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin