TY - JOUR
T1 - Chemoradiation in locally advanced cervical carcinoma
T2 - An analysis of cisplatin dosing and other clinical prognostic factors
AU - Nugent, Elizabeth K.
AU - Case, Ashley S.
AU - Hoff, John T.
AU - Zighelboim, Israel
AU - DeWitt, Lorri L.
AU - Trinkhaus, Kim
AU - Mutch, David G.
AU - Thaker, Premal H.
AU - Massad, L. Stewart
AU - Rader, Janet S.
PY - 2010/3
Y1 - 2010/3
N2 - Objectives: The aim of this study was to evaluate the effect of number of chemotherapy cycles and other clinical and pathologic factors on progression-free (PFS) and overall survival (OS) in patients with newly diagnosed cervical cancer. Methods: We identified 118 patients with locally advanced cervical cancer (stages IB2-IVA) treated with combination weekly cisplatin (40 mg/m2) and radiation therapy (RT) between 2003 and 2007. Kaplan-Meier and Cox proportional hazard models were utilized to evaluate PFS and OS for associations with number of chemotherapy cycles and other factors. Results: The majority of patients had stage IB2 or II disease (70%), squamous histology (91%), and size < 6 cm (65%). Median RT duration was 50 days and 95% received brachytherapy. Thirty percent of patients completed < 6 cycles of chemotherapy, and estimated PFS and OS were 63% and 75%, respectively. In multivariate analyses, the number of chemotherapy cycles was independently predictive of PFS and OS. Patients who received < 6 cycles of cisplatin had a worse PFS (HR 2.65; 95% CI 1.35-5.17; p = 0.0045) and OS (HR 4.47; 95% CI 1.83-10.9; p = 0.001). Advanced stage, longer time to RT completion, and absence of brachytherapy were also associated with decreased OS and PFS (p < 0.05). Similar results were found when analysis was conducted using a breakpoint of at least five but not less than five chemotherapy cycles. Higher grade was associated with decreased PFS (p = 0.03) but not OS. Age, race, BMI, tumor size, smoking, histology, and IMRT were not statistically significant for OS or PFS. Conclusions: Aggressive supportive care to minimize missed chemotherapy treatments may improve survival after chemoradiation.
AB - Objectives: The aim of this study was to evaluate the effect of number of chemotherapy cycles and other clinical and pathologic factors on progression-free (PFS) and overall survival (OS) in patients with newly diagnosed cervical cancer. Methods: We identified 118 patients with locally advanced cervical cancer (stages IB2-IVA) treated with combination weekly cisplatin (40 mg/m2) and radiation therapy (RT) between 2003 and 2007. Kaplan-Meier and Cox proportional hazard models were utilized to evaluate PFS and OS for associations with number of chemotherapy cycles and other factors. Results: The majority of patients had stage IB2 or II disease (70%), squamous histology (91%), and size < 6 cm (65%). Median RT duration was 50 days and 95% received brachytherapy. Thirty percent of patients completed < 6 cycles of chemotherapy, and estimated PFS and OS were 63% and 75%, respectively. In multivariate analyses, the number of chemotherapy cycles was independently predictive of PFS and OS. Patients who received < 6 cycles of cisplatin had a worse PFS (HR 2.65; 95% CI 1.35-5.17; p = 0.0045) and OS (HR 4.47; 95% CI 1.83-10.9; p = 0.001). Advanced stage, longer time to RT completion, and absence of brachytherapy were also associated with decreased OS and PFS (p < 0.05). Similar results were found when analysis was conducted using a breakpoint of at least five but not less than five chemotherapy cycles. Higher grade was associated with decreased PFS (p = 0.03) but not OS. Age, race, BMI, tumor size, smoking, histology, and IMRT were not statistically significant for OS or PFS. Conclusions: Aggressive supportive care to minimize missed chemotherapy treatments may improve survival after chemoradiation.
KW - Cancer
KW - Cervix
KW - Chemoradiation
UR - http://www.scopus.com/inward/record.url?scp=75749110904&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2009.09.045
DO - 10.1016/j.ygyno.2009.09.045
M3 - Article
C2 - 19896180
AN - SCOPUS:75749110904
SN - 0090-8258
VL - 116
SP - 438
EP - 441
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -