Abstract
Aim: To identify concurrent chemoradiotherapy (CCRT)-related late toxicities in locally advanced cervical cancer treatment, and clarify their causal relationship with prognosis.
Methods: We conducted a retrospective study on Stage IB2 to IVA cervical cancer in patients who were diagnosed at facilities participating in the Gynecologic Oncology Trial and Investigation Consortium (GOTIC) and treated with CCRT between 2001 and 2010.
Results: In total, 304 eligible patients were enrolled. The median follow-up duration was 79.3 months (range, 1.2–162.9 months) for all patients. Overall late toxicities of G3 or more involved 32 cases (10.5%). The 5-year cumulative rates of Grade ≥ 3 late toxicities of the small bowel, rectum, and bladder were 3.7% (95% CI 1.9%–7.1%), 3.8% (95% CI 2.1%–7.0%), and 3.2% (95% CI 1.5%–6.7%), respectively. Multivariate analysis showed a statistically significant association between small bowel toxicities and
histological type (Hazard ratio: 0.16, 95% CI: 0.04–0.68, P=.02) or chemotherapy (Hazard ratio: 0.17, 95% CI: 0.04–0.70, P=.02). The 5-year overall survival (OS) for all patients was 66.3% (95% CI 60.7%–71.9%). Age, Performance Status, clinical stage, Intracavity Brachytherapy, and late toxicities of the rectum showed a statistically significant impact on OS.
Conclusions: Regarding late toxicities, CCRT can be considered a standard treatment in the management of locally advanced cervical cancer.
The findings of this study provide a basis for comparison with current various radiation treatment methods and new chemotherapy strategies using immuno-checkpoint inhibitors.
