Toxicity of combined radiotherapy and cisplatin in patients with FIGO stage IB, IIB and IIIB cervical cancer undergoing radiochemotherapy
Affiliation and adress for correspondence

1 Klinika Ginekologii Onkologicznej, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie.
Kierownik Kliniki: prof. dr hab. n. med. Beata Śpiewankiewicz
2 Zakład Teleradioterapii, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie.
Kierownik Zakładu: prof. dr hab. n. med. Lucyna Kępka
Correspondence to: Klinika Ginekologii Onkologicznej, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie,
ul. Roentgena 5, 02-781 Warszawa
Source of financing: Department own sources

CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 204-214
ABSTRACT

Cervical cancer is the sixth most common malignancy in the females worldwide. At the time of detection, over one-half of the patients present with locally advanced disease. Radiotherapy is currently the mainstay of treatment of advanced cervical cancer. The aim of this paper was a critical assessment of tolerance of critical organs to combined radiochemotherapy. Study material consisted of 726 consecutive patients diagnosed with cervical cancer confirmed by histological study at FIGO stages IB, IIB and IIIB, qualified for combined radiochemotherapy at the Department of Oncologic Gynecology at the The Maria Skłodowska-Curie Institute of Oncology in Warsaw. Initially, all patients received external beam radiotherapy over the pelvis encompassing their genital system and electively regional lymph nodes. Patients were irradiated using photons X at 6-15 MeV. Total doses ranged from 44 to 50 Gy, in 2 Gy fractions 5 days-a-week. Hematological toxicity was assessed using NCI-approved tables based of the RTOG/EORTC scale for early radiation-induced bone-marrow reaction. Anemia (Hg<11.0 g/dl) was noticed in 67 (9.8%) patients. In the group of patients under 60, anemia was noticed in 54/494 (10.9%) cases, while in those over 60 – in 13/187 (7%) cases. Thrombocytopenia (PLT<100×109/L) developed in 36 (5.3%) cases. In 242 out of 292 patients diagnosed with leukopenia at grades 2, 3 or 4, this resulted in non-administration of the entire, preplanned number of chemotherapy courses. Conclusions: 1) Combined treatment of late-stage cervical cancer by radiochemotherapy increases toxicity, mainly hematological. Therefore nearly 1/3 of the patients have not received preplanned courses of cisplatin. 2) Slightly increased toxicity in elderly patients did not affect the radiochemotherapy protocol. 3) Early radiationinduced reactions on the part of urinary and digestive systems did not affect the preplanned therapy.

Keywords: cervical cancer, microbiological study, radiation-induced complications, radiotherapy, urine culture