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Title: Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-era Analysis

Abstract

Purpose: To compare rates of severe late toxicities following concomitant chemoradiotherapy and radiotherapy alone for cervical cancer. Methods and Materials: Patients with cervical cancer were treated at a single institution with radiotherapy alone or concomitant chemoradiotherapy for curative intent. Severe late toxicity was defined as grade {>=}3 vaginal, urologic, or gastrointestinal toxicity or any pelvic fracture, using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE), occurring {>=}6 months from treatment completion and predating any salvage therapy. Severe late toxicity rates were compared after adjusting for pertinent covariates. Results: At 3 years, probability of vaginal severe late toxicity was 20.2% for radiotherapy alone and 35.1% for concomitant chemoradiotherapy (P=.026). At 3 years, probability of skeletal severe late toxicity was 1.6% for radiotherapy alone and 7.5% for concomitant chemoradiotherapy (P=.010). After adjustment for case mix, concomitant chemoradiotherapy was associated with higher vaginal (hazard ratio [HR] 3.0, 95% confidence interval [CI], 1.7-5.2, P<.001), and skeletal (HR 7.0, 95% CI 1.4-34.1, P=.016) severe late toxicity. Compared to high dilator compliance, moderate (HR 3.6, 95% CI 2.0-6.5, P<.001) and poor (HR 8.5, 95% CI 4.3-16.9, P<.001) dilator compliance was associated with higher vaginal severe late toxicity. Age >50 was associated with higher vaginal (HRmore » 1.8, 95% CI 1.1-3.0, P=.013) and skeletal (HR 5.7, 95% CI 1.2-27.0, P=.028) severe late toxicity. Concomitant chemoradiotherapy was not associated with higher gastrointestinal (P=.886) or urologic (unadjusted, P=.053; adjusted, P=.063) severe late toxicity. Conclusion: Compared to radiotherapy alone, concomitant chemoradiotherapy is associated with higher rates of severe vaginal and skeletal late toxicities. Other predictive factors include dilator compliance for severe vaginal late toxicity and age for severe vaginal and skeletal late toxicities.« less

Authors:
 [1]; ; ;  [1];  [1];  [2];  [3];  [2]; ;  [1]
  1. Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, Wisconsin (United States)
  2. (United States)
  3. Arizona Cancer Specialists, Phoenix, Arizona (United States)
Publication Date:
OSTI Identifier:
22149638
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; COMBINED THERAPY; FRACTURES; HEALTH HAZARDS; NEOPLASMS; PATIENTS; PROBABILITY; RADIOTHERAPY; TOXICITY

Citation Formats

Gondi, Vinai, E-mail: gondi@humonc.wisc.edu, Bentzen, Soren M., Sklenar, Kathryn L., Dunn, Emily F., Petereit, Daniel G., John T. Vucurevich Cancer Care Institute, Rapid City Regional Hospital, Rapid City, South Dakota, Tannehill, Scott P., Department of Radiation Oncology, University of Arizona, Tuscon, Arizona, Straub, Margaret, and Bradley, Kristin A. Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-era Analysis. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.064.
Gondi, Vinai, E-mail: gondi@humonc.wisc.edu, Bentzen, Soren M., Sklenar, Kathryn L., Dunn, Emily F., Petereit, Daniel G., John T. Vucurevich Cancer Care Institute, Rapid City Regional Hospital, Rapid City, South Dakota, Tannehill, Scott P., Department of Radiation Oncology, University of Arizona, Tuscon, Arizona, Straub, Margaret, & Bradley, Kristin A. Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-era Analysis. United States. doi:10.1016/J.IJROBP.2012.01.064.
Gondi, Vinai, E-mail: gondi@humonc.wisc.edu, Bentzen, Soren M., Sklenar, Kathryn L., Dunn, Emily F., Petereit, Daniel G., John T. Vucurevich Cancer Care Institute, Rapid City Regional Hospital, Rapid City, South Dakota, Tannehill, Scott P., Department of Radiation Oncology, University of Arizona, Tuscon, Arizona, Straub, Margaret, and Bradley, Kristin A. Thu . "Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-era Analysis". United States. doi:10.1016/J.IJROBP.2012.01.064.
@article{osti_22149638,
title = {Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-era Analysis},
author = {Gondi, Vinai, E-mail: gondi@humonc.wisc.edu and Bentzen, Soren M. and Sklenar, Kathryn L. and Dunn, Emily F. and Petereit, Daniel G. and John T. Vucurevich Cancer Care Institute, Rapid City Regional Hospital, Rapid City, South Dakota and Tannehill, Scott P. and Department of Radiation Oncology, University of Arizona, Tuscon, Arizona and Straub, Margaret and Bradley, Kristin A.},
abstractNote = {Purpose: To compare rates of severe late toxicities following concomitant chemoradiotherapy and radiotherapy alone for cervical cancer. Methods and Materials: Patients with cervical cancer were treated at a single institution with radiotherapy alone or concomitant chemoradiotherapy for curative intent. Severe late toxicity was defined as grade {>=}3 vaginal, urologic, or gastrointestinal toxicity or any pelvic fracture, using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE), occurring {>=}6 months from treatment completion and predating any salvage therapy. Severe late toxicity rates were compared after adjusting for pertinent covariates. Results: At 3 years, probability of vaginal severe late toxicity was 20.2% for radiotherapy alone and 35.1% for concomitant chemoradiotherapy (P=.026). At 3 years, probability of skeletal severe late toxicity was 1.6% for radiotherapy alone and 7.5% for concomitant chemoradiotherapy (P=.010). After adjustment for case mix, concomitant chemoradiotherapy was associated with higher vaginal (hazard ratio [HR] 3.0, 95% confidence interval [CI], 1.7-5.2, P<.001), and skeletal (HR 7.0, 95% CI 1.4-34.1, P=.016) severe late toxicity. Compared to high dilator compliance, moderate (HR 3.6, 95% CI 2.0-6.5, P<.001) and poor (HR 8.5, 95% CI 4.3-16.9, P<.001) dilator compliance was associated with higher vaginal severe late toxicity. Age >50 was associated with higher vaginal (HR 1.8, 95% CI 1.1-3.0, P=.013) and skeletal (HR 5.7, 95% CI 1.2-27.0, P=.028) severe late toxicity. Concomitant chemoradiotherapy was not associated with higher gastrointestinal (P=.886) or urologic (unadjusted, P=.053; adjusted, P=.063) severe late toxicity. Conclusion: Compared to radiotherapy alone, concomitant chemoradiotherapy is associated with higher rates of severe vaginal and skeletal late toxicities. Other predictive factors include dilator compliance for severe vaginal late toxicity and age for severe vaginal and skeletal late toxicities.},
doi = {10.1016/J.IJROBP.2012.01.064},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}