Related Experiment Video
Updated: Jan 17, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Identifying Leukopenia, Renal Dysfunction and Other Factors Limiting Concomitant Chemoradiotherapy in Locally
Samuel Vokurka1, Lubos Mastny2, Radovan Vojtisek2
1Department of Oncology and Radiotherapeutics, Centre for Palliative and Supportive Medicine, University Hospital and Charles University Faculty of Medicine in Pilsen, Pilsen, CZE.
Introduction:
Concomitant chemoradiotherapy (CHRT) with weekly cisplatin and image-guided adaptive brachytherapy (IGABT) is the standard treatment for unresectable locally advanced cervical cancer. It has been shown that receiving five or more cycles of concomitant chemotherapy (CHT) significantly improves recurrence-free and overall survival. In this study, we analysed the factors contributing to the omission of concomitant chemotherapy within a patient cohort.
Methods:
In this single-centre retrospective study, we analysed medical records of 191 patients treated at our facility (Department of Oncology and Radiotherapeutics, University Hospital Pilsen, Czech Republic) from 2012 to 2024 to identify factors preventing optimal CHT administration. Included patients were those with newly diagnosed locally advanced, unresectable cervical cancer, where concomitant platinum-based CHRT with IGABT was indicated.
Results:
Of the patients, 15% (29/191) received no concomitant CHT, primarily due to concerns about toxicity, patient frailty/comorbidities, and renal insufficiency, with a statistically significant age difference in those who received CHT versus those who did not: mean 55.03 (±SD11.89) vs. 63.52 (±SD12.14) years (95% CI 3.74-13.23, p=0.0005). Among patients who initiated concomitant CHT but received four or fewer cycles (92/162, 57%), leukopenia was the most common independent limiting factor, followed by decreased renal function. Other factors included nausea, diarrhea, and administrative reasons.
Conclusion:
Leukopenia and renal dysfunction were primary barriers to completing optimal concomitant CHT in a significant number of patients. We advocate for increased emphasis on supportive care, including granulocyte colony-stimulating factor (G-CSF) use in leukopenia/neutropenia prevention or treatment, and meticulous management of renal functions. Individualized renal assessment, not just 'cisplatin-unfit' criteria, is crucial. Further research on G-CSFs in CHRT is warranted.
Related Concept Videos
01:27Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
01:28Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:18Chronic Kidney Disease IV: Nursing Management