Long-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes
| Autor: | Robert Y. Kim, David G. Mutch, K. Heydon, Patricia J. Eifel, Perry W. Grigsby |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty medicine.medical_treatment Brachytherapy Uterine Cervical Neoplasms Adenocarcinoma Carcinoma Adenosquamous Antineoplastic Combined Chemotherapy Protocols medicine Carcinoma Humans Radiology Nuclear Medicine and imaging Radiation Injuries Cervix Lymph node Aged Neoplasm Staging Cervical cancer Chemotherapy Lymphatic Irradiation Radiation business.industry Radiotherapy Dosage Middle Aged medicine.disease Combined Modality Therapy Acute toxicity Surgery Radiation therapy medicine.anatomical_structure Oncology Lymphatic Metastasis Carcinoma Squamous Cell Feasibility Studies Female Fluorouracil Cisplatin business Follow-Up Studies |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 51:982-987 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/s0360-3016(01)01723-0 |
| Popis: | Purpose: The purpose of this study was to evaluate the late toxicity and efficacy of twice-daily external irradiation to the pelvis and lumbar para-aortic region with brachytherapy and concurrent chemotherapy for carcinoma of the cervix with positive para-aortic lymph nodes. Patients and Methods: This study was designed to administer twice-daily radiation doses of 1.2 Gy to the pelvis and lumbar para-aortic lymph nodes (simultaneously) at 4–6-h intervals, 5 days per week. The total external radiation doses were 24–48 Gy to the whole pelvis, 12–36 Gy parametrial boost, and 48 Gy to the lumbar para-aortic region with an additional boost to a total dose 54–58 Gy to the positive para-aortic lymph node(s). One or two intracavitary implants were performed to deliver a minimum total dose of 85 Gy to point A. Cisplatin (75 mg/m 2 ; Days 1, 22, and 43) and 5-fluorouracil (1,000 mg/m 2 /24 h × 4 consecutive days, beginning on Days 1, 22, and 43) were given for two or three cycles. Results: Thirty patients with clinical Stages I–IV carcinoma of the cervix with biopsy-proven para-aortic lymph node metastases were enrolled in this study. Hyperfractionated external irradiation was completed in 87% (26 of 30). Brachytherapy was given in two implants to 47% (14 of 30) and in one implant to 33% (10 of 30); 13% (4 of 30) did not receive brachytherapy, 1 patient had three implants, and 1 had five high-dose-rate implants. Radiotherapy was completed per protocol in 70%. Three cycles of chemotherapy were given to 23% (7 of 30); 73% (22 of 30) received two cycles, and 1 patient did not receive chemotherapy. The acute toxicity from chemotherapy was Grade 1 in 3%, Grade 2 in 17%, Grade 3 in 48%, and Grade 4 in 28%. Acute toxicity from radiotherapy was Grade 1 in 7%, Grade 2 in 34%, Grade 3 in 21%, and Grade 4 in 28%. Late toxicity was Grade 1 in 10%, Grade 2 in 17%, Grade 3 in 7%, and Grade 4 in 17%. Grade 5 toxicity occurred in 1 patient during the course of therapy, but none had a late Grade 5 toxicity. The median follow-up time for the 7 patients alive at the time of last follow-up was 57 months. The overall survival estimates were 46% at 2 years and 29% at 4 years. The probability of local-regional failure was 40% at 1 year and 50% at 2 and 3 years. The probability of disease failure at any site was 46% at 1 year, 60% at 2 years, and 63% at 3 years. Conclusion: The results suggest that twice-daily external irradiation to the pelvis and lumbar para-aortic region with brachytherapy and concurrent chemotherapy resulted in an unacceptably high rate (17%, 5 of 29) of Grade 4 late toxicity. One patient died of acute complications of therapy. The survival estimates seem no better than standard fractionation irradiation without chemotherapy. |
| Databáze: | OpenAIRE |
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