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Prospective Study of Symptom Assessment Among Patients With Cervical Cancer During Concurrent Chemoradiotherapy With Weekly Cisplatin or Every-3-Week Cisplatin and 5-Fluorouracil
  1. Anna Likhacheva, MD, MPH*,
  2. Anuja Jhingran, MD*,
  3. Diane C. Bodurka, MD,
  4. Charlotte Sun, DrPH, MPH,
  5. Marianne Sam, MBA* and
  6. Patricia J. Eifel, MD*
  1. *Departments of Radiation Oncology, and
  2. Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Patricia J. Eifel, MD, 1220 Holcombe Blvd, Houston TX, 77030-4004. E-mail:


Purpose In this prospective study, symptoms were assessed in patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy (CTRT) with either weekly cisplatin (WP) or every-3-week cisplatin/5-fluorouracil (PF).

Materials and Methods Patients with 1994 International Federation of Gynecology and Obstetrics stage IIB to IVA disease, biopsy-proven involved pelvic nodes, or gross tumor size greater than 5 cm were eligible. Patients requiring paraaortic radiotherapy were excluded. With the use of a modified Edmonton Symptom Assessment Scale, patients reported symptom severity on an 11-point scale 3 times per week during CTRT and at the first follow-up. The Wilcoxon rank sum test and multilevel mixed-effects linear regression were used to assess the effect of chemotherapy regimen on symptoms.

Results Among the 52 patients included in the final analysis, 37 received WP, 13 received PF, and 2 received 1 cycle of PF followed by WP. Overall compliance with completion of Edmonton Symptom Assessment Scale questionnaires was 75%. There were significant differences in symptom scores for well-being, anorexia, fatigue, diarrhea, and stomatitis favoring the WP regimen. All symptoms except diarrhea were stable and of low intensity in the WP group. In the PF group, symptoms had a cyclical pattern with an initial rise followed by a gradual fall during the 3-week period after chemotherapy. For the 29 patients (56%) who completed the follow-up surveys, scores for all symptoms improved to baseline levels 4 to 6 weeks after treatment.

Conclusions This analysis provides important patient-reported data regarding the rates and timing of acute symptoms during CTRT that can help clinicians better manage symptoms that impact patients’ quality of life.

  • Cervix cancer
  • Radiotherapy
  • Acute toxic effects
  • Patient-reported symptoms
  • Chemoradiotherapy

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  • The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health through Cancer Center Support Grant CA016672.

  • The authors declare no conflicts of interest.