Chemotherapy-related toxicity in patients receiving concurrent chemoradiation for locally advanced cervical cancer

Background

In South Africa the majority of cases of cervical cancer are locally advanced. Radiotherapy with weekly Cisplatin, 40mg/m², is the treatment of choice. This dosage is often tolerated poorly in the developing world. This study determined the frequency of severe chemotherapy-related toxicity, at a dosage of 30mg/m² in patients receiving radical chemoradiotherapy.

Methods

A retrospective review was performed of patients receiving concurrent chemoradiation for cervical cancer, using weekly Cisplatin, 30mg/m². The frequency of severe chemotherapy-related toxicity (grade 3 and 4) was determined in the following categories: haematologic, renal and upper gastro-intestinal tract toxicity. In order to determine the tolerability of weekly Cisplatin, the number of completed cycles was compared to the intended number, and the average number of cycles completed by each patient was calculated. Age, FIGO stage and HIV status were confounding variables included in the analysis.

Results

The incidence of severe toxicity was low, with renal toxicity (17%) the most common. FIGO stage and HIV status did not influence toxicity significantly. Patients older than 50 years showed a trend for higher toxicity, p-value = 0.094. Approximately three quarter of planned chemotherapy cycles were administered. Sixty-eight per cent of patients received four or five doses of Cisplatin. The remainder received three cycles or less which was deemed inadequate. Reasons for omitted doses were not only toxicity but also included logistical and administrative issues. Outcome data will be presented.

Conclusions

Weekly Cisplatin, 30mg/m², with chemoradiation for cervical cancer is well tolerated. HIV infection did not influence toxicity, but patients over 50 years may have increased risk for adverse events. Stricter adherence to guidelines is recommended.

Clinical trial identification

Legal entity responsible for the study

University of Pretoria, South Afrca Steve Biko Academic Hospital, Pretoria, South Africa

Funding

Personal funds

Disclosure

All authors have declared no conflicts of interest.