title: Toxicity and early clinical outcomes in cervical cancer following extended field helical tomotherapy to para-aortic lymph nodes.
abstract: OBJECTIVE
  To evaluate toxicity and early disease outcome among patients treated for cervical cancer with extended-field helical tomotherapy to the para-aortic nodes.
  
  
  METHODS
  Thirty-eight patients (International Federation of Gynecology and Obstetrics [FIGO] stage IB2-IVA) from four institutions received extended-field helical tomotherapy and were retrospectively evaluated. All had nodal disease. Para-aortic lymph nodes were involved in 31 patients. Patients were assessed for toxicity using version 4 of the National Cancer Institute's common terminology criteria for adverse events. Survival curves were plotted using Kaplan-Meier estimates.
  
  
  RESULTS
  All patients underwent radiation to the tumor region (median dose: 45Gy; range: 44-66Gy), pelvic lymph nodes and para-aortic lymph nodes (median dose: 45Gy; range: 44-60Gy). The median dose to positive lymph nodes was 55Gy (range: 45-65Gy). All received platinum-based chemotherapy (31 concurrently). The median follow-up was 15months. Acute toxicity events observed included one patient with grade 5 febrile neutropenia, 11 patients (29%) with grade 3 hematologic complications. Grades 3-4 gastrointestinal and genitourinary toxicities occurred in six (16%) and four (11%) patients, respectively. Three patients had grade 3 pelvic pain (8%). The 6- and 18-month overall survival rates were 94.7 and 63.9%, respectively. The 18-month locoregional control, disease-free survival, and late grade 3 toxicity rates were 60.2, 43.3 and 7.3%, respectively.
  
  
  CONCLUSIONS
  Extended-field helical tomotherapy was associated with low rates of acute gastrointestinal and genitourinary toxicities with early survival and locoregional control similar to other published series.
authors.affiliation: Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France. Electronic address: emmanueljouglar@yahoo.fr.
authors.forename: E
authors.initials: E
authors.lastname: Jouglar
authors.affiliation: Department of Radiation Oncology, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue de l'Ulm, 75005 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: de la Rochefordière
authors.affiliation: Department of Radiation Oncology, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France.
authors.forename: G
authors.initials: G
authors.lastname: Noël
authors.affiliation: Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
authors.forename: M
authors.initials: M
authors.lastname: Le Blanc-Onfroy
authors.affiliation: Department of Medical Physics, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
authors.forename: G
authors.initials: G
authors.lastname: Delpon
authors.affiliation: Department of Statistics, Institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
authors.forename: L
authors.initials: L
authors.lastname: Campion
authors.affiliation: Department of Radiation Oncology, institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Mahé
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Cancer du col utérin; Cervical cancer; Chimiothérapie concomitante; Concurrent chemotherapy; Extended field; Helical tomotherapy; Intensity modulated radiation therapy; Lomboaortique; Para-aortic lymph nodes; Radiothérapie avec modulation d’intensité; Tomothérapie hélicoïdale