Multi-institutional Observational Study of Prophylactic Extended-Field Concurrent Chemoradiation Therapy Using Weekly Cisplatin for Patients With Pelvic Node-Positive Cervical Cancer in East and Southeast Asia

Wakatsuki M 1 , Kato S 2 , Ohno T 3 , Banu PA 4 , Hoang NC 5 , Yadamsuren E 6 Show all authors , Supriana N 7 , Cao J 8 , Devi CRB 9 , Calaguas MJ 10 , Chansilpa Y 11 , Cho CK 12 , Adylkhanov T 13 , Okonogi N 14 , Nakano T 3 , Tsujii H 14

Affiliations 

  • 1 Department of Radiology, Jichi Medical University, Tochigi, Japan. Electronic address: wakkun100@yahoo.co.jp
  • 2 Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
  • 3 Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
  • 4 Department of Radiation Oncology, Delta Hospital Limited, Dhaka, Bangladesh
  • 5 Department of General Radiation Oncology, National Cancer Hospital, Hanoi, Vietnam
  • 6 Department of Radiation Oncology, National Cancer Center of Mongolia, Ulaanbaatar, Mongolia
  • 7 Department of Radiotherapy, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 8 Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
  • 9 Department of Radiation Oncology, Sarawak General Hospital, Kuching, Malaysia
  • 10 Department of Radiation Oncology, St Luke's Medical Center, Quezon City, Philippines
  • 11 Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 12 Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
  • 13 Department of Oncology and Visual Diagnostics, Semey State Medical University, Semey, Kazakhstan
  • 14 National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
Int J Radiat Oncol Biol Phys, 2019 09 01;105(1):183-189.
PMID: 31125594 DOI: 10.1016/j.ijrobp.2019.04.039

Abstract

PURPOSE: This multi-institutional observational study conducted among 11 countries in East and Southeast Asia aimed to assess the clinical outcomes of prophylactic extended-field concurrent chemoradiation therapy using weekly cisplatin for patients with locally advanced cervical cancer.

METHODS AND MATERIALS: Between October 2007 and May 2016, 106 patients with untreated squamous cell carcinoma of the cervix were enrolled in the present study. Radiation therapy consisted of pelvic irradiation (total dose, 50 Gy in 25 fractions including central shielding), prophylactic paraortic regional irradiation (36-40 Gy in 20 fractions), and either high- or low-dose-rate intracavitary brachytherapy (ICBT) according to institutional practice. The planned point A dose was 21 to 28 Gy in 3 to 4 fractions for high-dose-rate ICBT and 40 to 41 Gy in 1 to 2 fractions for low-dose-rate ICBT. Five cycles of weekly cisplatin (40 mg/m2) were administered during the radiation therapy course.

RESULTS: A total of 106 patients were enrolled. Of these, 9 had major protocol violations and 2 did not receive treatment because of worsened general condition. Thus, 95 patients were evaluable. The median follow-up was 56 months. Of the 95 patients, 76 (80%) received 4 or 5 cycles of chemotherapy. Acute grade 3 leukopenia was observed in 20 of the patients (21%), and late grade 3 gastrointestinal toxicity was observed in 3%. The 2-year local control, progression-free survival, and overall survival rate for all patients were 96%, 78%, and 90%, respectively.

CONCLUSIONS: The results indicated that prophylactic extended-field concurrent chemoradiation therapy using weekly cisplatin is feasible and effective for patients with locally advanced cervical cancer in East and Southeast Asia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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