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Concurrent Chemoradiotherapy Incorporating High-Dose Rate Brachytherapy for Locally Advanced Cervical Carcinoma: Survival Outcomes, Patterns of Failure, and Prognostic Factors
  1. Jonathan Teh, MBBS*,
  2. Swee Peng Yap, FRCR*,
  3. Ivan Tham, FRCR,
  4. Vijay K. Sethi, DMRT*,
  5. Eu Jin Chua, DMRT*,
  6. Richard Yeo, FRCR*,
  7. Tew Hong Ho, FRCOG,
  8. Eng Hseon Tay, FRCOG§,
  9. Yin Nin Chia, MRCOG,
  10. Lay Tin Soh, MRCP and
  11. Hoon Seng Khoo-Tan, FRCR*
  1. *Department of Radiation Oncology, National Cancer Centre Singapore;
  2. Department of Radiation Oncology, National University Cancer Institute, Singapore;
  3. Gynaecological Oncology Unit, KK Women's and Children's Hospital;
  4. §Thomson Women Cancer Centre; and
  5. Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
  1. Address correspondence and reprint requests to Jonathan Teh, MBBS, Department of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610, Republic of Singapore. E-mail:


Background: This is a retrospective study evaluating the survival outcomes, patterns of failure, and prognostic factors of chemoradiotherapy incorporating high-dose rate brachytherapy in the treatment of locally advanced cervical cancer.

Methods: A review of 120 consecutive patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stages IB2 to IVA cervical cancer treated with concurrent cisplatin-based chemoradiotherapy between April 1999 and January 2005. Overall (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method.

Results: The 5-year OS and DFS rates were, respectively, 65.0% (35.0% IB2, 65.7% IIA-B, 71.0% IIIA-B, and 40.0% IVA) and 57.3% (30.0% IB2, 58.2% IIA-B, 64.0% IIIA-B, and 40.0% IVA). Most patients had squamous cell carcinoma (89.2%) and belonged to FIGO stages IIB (40.8%) and IIIB (30.8%). All but 4 patients completed the planned radiotherapy regimen. There were 48 documented recurrences, of which 13 were locoregional only, 26 were distant only, and 9 were both sites. Five patients (4.2%) experienced late grade 3 to 4 gastrointestinal toxicity. On multivariate analysis, a preradiotherapy hemoglobin level of less than 10 g/dL and tumor size of 4 cm or greater or bulky on computed tomography were independently significant variables for OS, whereas a nadir hemoglobin level of less than 10 g/dL and presence of radiologically enlarged pelvic or paraaortic lymph nodes were independently significant variables for DFS.

Conclusions: We conclude that this regimen is efficacious and feasible, but the safety profile about concurrent administration of high-dose rate brachytherapy and chemotherapy should be studied further. Finally, for cervical cancer patients selected for nonsurgical treatment, radiological assessment of tumor size and lymph node status can provide valuable prognostic information over and above FIGO staging alone.

  • Cervical cancer
  • Chemoradiotherapy
  • Prognostic factors
  • Survival
  • Locally advanced

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  • There is no funding received from the National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, or any other institution.