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Original Research

Open Access

Definitive radiotherapy in elderly patients and patientswith locally advanced cervical cancer with complications

  • H. Imafuku1,*,
  • Y. Ebina1
  • K. Suzuki1
  • S. Wakahashi1
  • Y. Miyahara1
  • K. Yoshida2
  • H. Yamada1

1Department of Obstetrics and Gynecology, Kobe City (Japan)

2Department of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City (Japan)

DOI: 10.31083/j.ejgo.2020.01.4769 Vol.41,Issue 1,February 2020 pp.60-64

Published: 15 February 2020

*Corresponding Author(s): H. Imafuku E-mail:


Objective: To analyze the efficacy and toxicity of radiation therapy (RT) in elderly patients (>80-years-old) and patients with locallyadvanced cervical cancer with complications. Materials and Methods: Thirty-six patients treated with RT and 52 patients treated withconcurrent chemoradiation therapy (CCRT) between 2010 and 2013 were included in this study. Treatment efficacy, treatment toxicity, overall survival, disease progression-free survival, and pelvic progression-free survival were analyzed. Results: The frequency of patients who had Grade 3-4 leukopenia in the CCRT group (57.6%) was significantly higher than that in the RT group (8.3%, p< 0.01). The complete response rates were 84% in the RT group (n = 32) and 90% in the CCRT group (n = 51) (p = 0.498). There was no statistical difference in overall survival, disease progression-free survival, and pelvic progression-free survival between the RT group andthe CCRT group. Conclusion: Definitive RT in elderly and complicated cervical cancer patients was safe and effective.


Cervical cancer; Radiation therapy; Elderly patients; Patients with complications.

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H. Imafuku,Y. Ebina,K. Suzuki,S. Wakahashi,Y. Miyahara,K. Yoshida,H. Yamada. Definitive radiotherapy in elderly patients and patientswith locally advanced cervical cancer with complications. European Journal of Gynaecological Oncology. 2020. 41(1);60-64.


[1] Hori M., Matsuda T., Shibata A., Katanoda K., Sobue T., NishimotoH.: “Cancer incidence and incidence rates in Japan in 2009: a studyof 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project”. Jpn. J. Clin. Oncol., 2015, 45, 884.

[2] Ebina Y., Yaegashi N., Katabuchi H., Nagase S., Udagawa Y., Hachisuga T., Saito T., et al.: “Japan Society of Gynecologic Oncology guidelines 2011 for the treatment of uterine cervical cancer”. Int. J. Clin. Oncol., 2015, 20, 240.

[3] Eifel P.J.,Winter K., Morris M., Levenback C., Grigsby P.W.,Cooper J. Rotman M., et al.: “Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01”. J. Clin. Oncol., 2004, 22, 872.

[4] Morris M., Eifel P.J., Lu J., Grigsby P.W., Levenback C., StevensR.E., Rotman M., et al.: “Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer”. The New England journal of medicine, 1999, 340, 1137-43.

[5] Of, O.: “Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials”. J. Clin. Oncol., 2008, 26, 5802.

[6] Rose P.G., Bundy B.N., Watkins E.B., Thigpen J.T., Deppe G., Maiman M.A., Pearson D. L.C., et al.: “Concurrent cisplatin-basedradiotherapy and chemotherapy for locally advanced cervical cancer”. The New England journal of medicine, 1999, 340, 1144.

[7] Whitney C.W., Sause W., Bundy B.N., Malfetano J.H., HanniganE.V., Fowler W.C., Jr., Pearson D. L.C., et al.: “Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervixwith negative para-aortic lymph nodes: a Gynecologic OncologyGroup and Southwest Oncology Group study”. J. Clin. Oncol., 1999, 17, 1339.

[8] Keys H.M., Bundy B.N., Stehman F.B., Muderspach L.I., ChafeW.E., Suggs C.L., 3rd, Walker J.L., et al.: “Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma”. N. Engl. J.Med., 1999, 340, 1154.

[9] Kirwan J.M., Symonds P., Green J.A., Tierney J., Collingwood M., Williams C.J.: “A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer”. Radiother. Oncol., 2003, 68, 217.

[10] Yoshida K., Sasaki R., Nishimura H., Miyawaki D., Kawabe T., Okamoto Y., Nakabayashi K., et al.: “Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity”. Arch. Gynecol. Obstet., 2011, 284, 1007.

[11] Monk B.J., Tewari K.S., Koh W.J.: “Multimodality Therapy for Locally Advanced Cervical Carcinoma: State of the Art and Future Directions.” J. Clin. Oncol. 2007, 25, 2952.

[12] Robin T.P.,Amini A., Schefter T.E., Behbakht K., Fisher C.M.: “Disparities in standard of care treatment and associated survival decrement in patients with locally advanced cervical cancer”. Gynecol. Oncol., 2016, 143, 319.

[13] Toita T., Kitagawa R., Hamano T., Umayahara K., Hirashima Y., Aoki Y., Oguchi M., et al.: “Feasibility and acute toxicity of Concurrent Chemoradiotherapy (CCRT) with high-dose rate intracavitary brachytherapy (HDR-ICBT) and 40-mg/m2 weekly cisplatin for Japanese patients with cervical cancer: results of a Multi-Institutional Phase 2 Study (JGOG1066)”. Int. J. Gynecol. Cancer, 2012, 22, 1420.

[14] Toita T., Kitagawa R., Hamano T., Umayahara K., Hirashima Y., Aoki Y., Oguchi M., et al.: “Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: efficacy and toxicity of a low cumulative radiation dose schedule”. Gynecol. Oncol., 2012, 126, 211.

[15] Chen S.W., Liang J.A., Hung Y.C., Yeh L.S., Chang W.C., Lin W.C., Yang S.N., et al.: “Concurrent weekly cisplatin plus external beam radiotherapy and high-dose rate brachytherapy for advanced cervical cancer: a control cohort comparison with radiation alone on treatment outcome and complications”. Int. J. Radiat. Oncol. Biol. Phys., 2006, 66, 1370.

[16] Kuroda Y., Murakami N., Morota M., Sekii S., Takahashi K., Inaba K., Matahara H., et al.: “Impact of concurrent chemotherapy on definitive radiotherapy for women with FIGO IIIb cervical cancer”. J. Radiat. Res., 2012, 53, 588.

[17] Pearcey R., Brundage M., Drouin P., Jeffrey J., Johnston D., Lukka H., MacLean G., et al.: “Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix”. J. Clin. Oncol., 2002, 20, 966.

[18] Sakata K., Sakurai H., Suzuki Y., Katoh S., Ohno T., Toita T., Kataoka M., et al.: “Results of concomitant chemoradiation for cervical cancer using high dose rate intracavitary brachytherapy: study of JROSG (Japan Radiation Oncology Study Group)”. Acta. Oncol., 2008, 47, 434.

[19] Serkies K., Jassem J.: “Concurrent weekly cisplatin and radiotherapy in routine management of cervical cancer: a report on patient compliance and acute toxicity”. Int. J. Radiat. Oncol. Biol. Phys., 2004, 60, 814.

[20] Tharavichitkul E., Pinitpatcharalerd A., Lorvidhaya V., Kamnerdsupaphon P., Pukanhaphan N., Sukthomya V., Chitapanarax I., et al.: “Impact of Incomplete Plan to Treatment Results of Concurrent Weekly Cisplatin and Radiotherapy in Locally Advanced Cervical Cancer”. J. Radiat. Res., 2011, 52, 9.

[21] Alvarez R.D., Soong S.J., Kinney W.K., Reid G.C., Schray M.F., Podratz K.C., Morley G. W., et al.: “Identification of prognostic factorsand risk groups in patients found to have nodal metastasis at the timeof radical hysterectomy for early-stage squamous carcinoma of thecervix”. Gynecol. Oncol., 1989, 35, 130.

[22] Chen S.W., Liang J.A., Yang S.N., Lin F.J.: “High dose-ratebrachytherapy for elderly patients with uterine cervical cancer”. Jpn. J. Clin. Oncol., 2003, 33, 221.

[23] Goodheart M., Jacobson G., Smith B.J., Zhou L.: “Chemoradiationfor invasive cervical cancer in elderly patients: outcomes and morbidity”. Int. J. Gynecol. Cancer, 2008, 18, 95.

[24] Hata M., Koike I., Miyagi E., Numazaki R., Asai-Sato M., KasuyaT., Kaizu H., et al.: “Radiation Therapy for Very Elderly PatientsAged 80 Years and Older With Squamous Cell Carcinoma of theUterine Cervix”. Am. J. Cinical Oncol., 2017, 40, 178.

[25] Ikushima H., Takegawa Y., Osaki K., Furutani S., Yamashita K., Kawanaka T., Kubo A., et al.: “Radiation therapy for cervical cancer in the elderly”. Gynecol. Oncol., 2007, 107, 339.

[26] Mitchell P.A., Waggoner S., Rotmensch J., Mundt A.J.: “Cervical cancer in the elderly treated with radiation therapy”. Gynecol. Oncol., 1998, 71, 291.

[27] Nosaka K., Shibata K., Utsumi F., Yoshida K., Niimi K., Sekiya R., Suzuki S., et al.: “Feasibility and benefit of concurrent chemoradiotherapy for elderly patients with uterine cervical cancer”. Tumori., 2016, 102, 600.

[28] Park J.H., Kim Y.S., Ahn S.D., Choi E.K., Shin S.S., Kim Y.T., KimY.M., et al.: “Concurrent chemoradiotherapy or radiotherapy alonefor locally advanced cervical cancer in elderly women”. Tumori., 2010, 96, 959.

[29] Sablinska B.: “Carcinoma of the uterine cervix in women over 70years of age”. Gynecol Oncol., 1979, 7, 128.

[30] Lindegaard J.C., Thranov I.R., Engelholm S.A.: “Radiotherapy inthe management of cervical cancer in elderly patients”. Radiother. Oncol., 2000, 56, 9.

[31] Minagawa Y., Kigawa J., Itamochi H., Terakawa N.: “The outcomeof radiation therapy in elderly patients with advanced cervical cancer”. Int J Gynaecol Obstet., 1997, 58, 305.

[32] Magne N., Mancy N.C., Chajon E., Duvillard P., Pautier P., Castaigne D., Lhomme C., et al.: “Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy”. Radiother. Oncol., 2009, 91, 197.

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