title: Concurrent chemoradiation versus radiotherapy alone for the treatment of locally advanced cervical cancer in a low-resource setting.
abstract: Our goal was to determine the clinical treatment response following radiation administered with or without chemotherapy for locally advanced cervical cancers in Honduras. This is a retrospective study of patients treated with either concurrent chemoradiation (CCRT) or external beam radiation therapy (EBRT) alone at a hospital in Tegucigalpa, Honduras. 70 Gy of EBRT to the pelvis was given in all cases. Brachytherapy was not available. Chemotherapy was given when available. Extrafascial hysterectomy was performed 6 weeks after completion of treatment in patients with a complete clinical response (cCR). Records for 165 women with locally advanced cervical cancer were reviewed; 25 (15.2%) stage IB2, 15 (9.1%) stage IIA, 90 (54.5%) stage IIB, and 35 (21.2%) stage IIIB. Ninety (54.5%) patients received EBRT alone; 75 (45.5%) received CCRT. Twenty-three (33.3%) of CCRT patients received weekly cisplatin, the remainder receiving other agents. Seventy (77.8%) of the 90 patients who received EBRT had a cCR; 25 out of 75 (33.3%) patients in the CCRT group achieved a cCR. The CCRT group treated with weekly cisplatin achieved an 80% cCR; while the CCRT group given alternative agents had only a 31% cCR. Patients unable to receive platinum-based CCRT had the worst outcome, and their responses were inferior to patients who received EBRT. The challenges of treating women with locally advanced cervical cancer in a low-resource setting are multifactorial and include treatment delays, the lack of brachytherapy and the unpredictable availability of chemotherapy.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Elena
authors.initials: E
authors.lastname: Pereira
authors.affiliation: Hospital San Felipe, Tegucigalpa, Honduras.
authors.forename: Hoover Henriquez
authors.initials: HH
authors.lastname: Cooper
authors.affiliation: Hospital San Felipe, Tegucigalpa, Honduras.
authors.forename: Pedro Guillermo
authors.initials: PG
authors.lastname: Zelaya
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: William
authors.initials: W
authors.lastname: Creasman
authors.affiliation: West Penn Allegheny Health System, Pittsburgh, PA, United States.
authors.forename: Fredric V
authors.initials: FV
authors.lastname: Price
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Linus
authors.initials: L
authors.lastname: Chuang
keywords: Adjuvant hysterectomy; Cervical cancer; Chemotherapy; Low-resource settings; Radiation