Chemoradiotherapy for Cervical Cancer in 2010

Klopp, Ann H.; Eifel, Patricia J.

doi:10.1007/s11912-010-0134-z

Cited by 27 publications

(21 citation statements)

References 71 publications

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“…HT can often limit the ability to deliver a full course of concurrent chemotherapy and is a major limitation to the introduction of additional cytotoxic agents (13). IMRT treatment planning for intact cervical cancer requires large margins on the cervix, perhaps on the order of several centimeters, to allow for uterine motion (14).…”

Section: Discussionmentioning

confidence: 99%

Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

Klopp

Moughan

Portelance

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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207

163

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Purpose Intensity modulated radiation therapy (IMRT), compared with conventional 4-field treatment, can reduce the volume of bone marrow irradiated. Pelvic bone marrow sparing has produced a clinically significant reduction in hematologic toxicity (HT). This analysis investigated HT in RTOG 0418, a prospective study to test the feasibility of delivering postoperative IMRT for cervical and endometrial cancer in a multi-institutional setting. Methods and Materials Patients in the RTOG 0418 study were treated with postoperative IMRT to 50.4 Gy to the pelvic lymphatics and vagina. Endometrial cancer patients received IMRT alone, whereas patients with cervical cancer received IMRT and weekly cisplatin (40 mg/m2). Pelvic bone marrow was defined within the treatment field by using a computed tomography–density–based auto-contouring algorithm. The volume of bone marrow receiving 10, 20, 30, and 40 Gy and the median dose to bone marrow were correlated with HT, graded by CTCAE v 3.0 criteria. Results Eighty-three patients were eligible for analysis (43 with endometrial cancer and 40 with cervical cancer). Patients with cervical cancer treated with weekly cisplatin and pelvic IMRT had grades 1-5 HT (23%, 33%, 25%, 0%, and 0% of patients, respectively). Among patients with cervical cancer, 83% received 5 or more cycles of cisplatin, and 90% received at least 4 cycles of cisplatin. The median percentage volume of bone marrow receiving 10, 20, 30, and 40 Gy in all 83 patients, respectively, was 96%, 84%, 61%, and 37%. Among cervical patients with a median percentage volume of > 37% who received 40 Gy (V40 > 37%), 75% had grade ≥ 2 HT compared with 40% of patients with a V40 ≤ 37% who had this grade (p = 0.025). Cervical patients with a median bone marrow dose of >34.2 Gy also had higher rates of grade ≥ 2 HT than did those with a dose of ≤ 34.2 Gy (74% vs. 43%, p = 0.049). Conclusions Pelvic IMRT with weekly cisplatin is associated with low rates of HT and high rates of weekly cisplatin use. The volume of bone marrow receiving 40 Gy and the median dose to bone marrow correlated with higher rates of grade ≥ 2 toxicity among patients receiving weekly cisplatin (cervical patients). Evaluation and limitation of the volume of bone marrow treated with pelvic IMRT is warranted in patients receiving concurrent chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

Klopp

Moughan

Portelance

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

Self Cite

207

163

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“…MRI-guided brachytherapy with the addition of interstitial needles has shown promise in improving local control [24]. New approaches to combining radiotherapy with chemotherapy or new molecular therapeutics targeted at radioresistance pathways [25] are needed to address the problem of distant relapse.…”

Section: Discussionmentioning

confidence: 99%

The Role of Elective Para-aortic Lymph Node Irradiation in Patients with Locally Advanced Cervical Cancer

et al. 2014

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“…Cervical cancer rates are decreasing among women in the United States, although incidence remains high among Hispanic/Latino, Black, and Asian women (Barnholtz-Sloan et al, 2009). Radiotherapy is the primary modality for curative treatment of locally advanced cervical cancer (Klopp et al, 2011). Several randomized trials revealed that treatment regimens combining radiotherapy with platinum-based chemotherapy improve rates of overall survival and progress-free survival in women with Stage ⅢB through ⅣA cervical cancer (Rose et al, 1999;Eifel et al, 2004;Kim et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Concurrent Weekly Cisplatin Versus Triweekly Cisplatin with Radiotherapy in the Treatment of Cervical Cancer: A Meta-analysis Result

Cai²,

Su³

2012

Asian Pacific Journal of Cancer Prevention

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Aims: To evaluate the adverse effect and survival outcome of weekly and triweekly cisplatin with radiotherapy in treatment of cervical cancer. Methods: After an extensive literature search between 1995-2011,we analyzed 7 studies to compare weekly cisplatin and triweekly cisplatin combined radiotherapy. Results: Our analysis established that weekly cisplatin has a lower risk of hematologic toxicity than triweekly cisplatin with concurrent radiotherapy in the treatment of cervical cancer. However, there were no differences in progression free survival and overall survival between weekly cisplatin and triweekly cisplatin (p>0.05). Conclusions: Weekly cisplatin combined with concurrent radiation has lower risk in hematologic toxicity than triweekly cisplatin, but does not improve survival. Triweekly cisplatin treatment has longer intervals and is therefore more convenient. Clinicians and patients can choose either weekly cisplatin or triweekly cisplatin combined radiotherapy for cervical cancer.

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Chemoradiotherapy for Cervical Cancer in 2010

Cited by 27 publications

References 71 publications

Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

The Role of Elective Para-aortic Lymph Node Irradiation in Patients with Locally Advanced Cervical Cancer

Concurrent Weekly Cisplatin Versus Triweekly Cisplatin with Radiotherapy in the Treatment of Cervical Cancer: A Meta-analysis Result

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