Acute toxicity of chemo-radiotherapy for cervical cancer: the Addenbrooke's experience

An audit of acute treatment-related toxicity during chemo-radiotherapy for cervical cancer was carried out to assess its tolerance outside research settings.

Between May 1999 and April 2003, 74 patients with carcinoma of the cervix were treated with radical radiotherapy given concurrently with weekly cisplatin chemotherapy. Fifty-nine (79.7%) patients received chemo-radiotherapy as primary radical treatment, 10 (13.5%) patients were treated adjuvantly for poor-prognosis features after radical surgery, and the remaining five (6.8%) were given chemo-radiotherapy for pelvic recurrences after previous surgery. Acute treatment-related toxicity was graded prospectively at weekly intervals during chemo-radiotherapy using the National Cancer Institute Common Toxicity Criteria.

The most common adverse effects were diarrhoea (80.6%), malaise (66.7%) and nausea (62.5%). The most common haematological toxicity was anaemia, with 41.7% patients developing grade 1 or 2 toxicity. Only three (4.2%) patients had grade 3 or 4 toxicity. One patient had grade 3 thrombocytopenia, another had grade 4 neutropenia and the third patient had grade 3 diarrhoea. A statistically significant correlation was found between maximum treatment-related toxicity, larger treatment volumes (P = 0.006) and disease stage (P = 0.04). A total of 97.3% of patients completed external beam radiotherapy without any interruptions for treatment-related toxicity. Only two patients (3.4%) experienced a delay in brachytherapy for treatment-related toxicity. Two patients died during external beam radiotherapy, and one patient suffered a fatal pulmonary embolism 1 week after completing brachytherapy treatment. A total of 70.2% patients completed the planned number of chemotherapy cycles, with a further 20.3% receiving at least three cycles. The most common reason for failure to complete chemotherapy as planned was gastrointestinal toxicity. There was no correlation between failure to complete planned chemotherapy and patient age, disease stage, radiotherapy treatment volumes or postoperative treatment.

Our study has shown that cisplatin-based chemo-radiotherapy for carcinoma of the cervix is well tolerated when given to a largely unselected population of patients outside research settings. The effectiveness of the treatment should therefore mirror the efficacy obtained in clinical trials.