Adjuvant pelvic intensity-modulated radiotherapy and concurrent docetaxel and cisplatin chemotherapy for postoperative cervical cancer with adverse risk factors: a retrospective report on toxicity and outcome in a single institution

Background: To retrospectively assess the toxicity of delivering postoperative intensity-modulated radiotherapy (IMRT) and concurrent cisplatin and docetaxel chemotherapy to patients with cervical cancer and adverse risk factors. Methods: Every patient received postoperative IMRT and concurrent cisplatin and docetaxel chemotherapy. The clinical target volume (CTV) included the regional lymph node regions (obturator, common, internal, and external iliacs and presacral and para-aortic regions); the upper 2.0 cm of the vagina; and paravaginal soft tissue lateral to the vagina. Acute and late toxicities were scored using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group (RTOG) late radiation morbidity scoring criteria, respectively. Results: Seventy-six patients were treated with postoperative IMRT and concurrent cisplatin and docetaxel chemotherapy. The median follow-up was 32 months. Eight patients (10.5%) had recurrence—loco-regional recurrence in four patients (5.3%) and distant metastasis in four (5.2%). Acute grade ≥3 gastrointestinal and hematologic toxicity occurred in one and five patients, respectively. One patient (1.3%) suffered from late grade 3 toxicities. Seventeen patients experienced ovarian transposition, 14 (82%) of whom maintained ovarian function. Seventy-four patients (97.4%) were alive at the last follow-up. Conclusions: Concurrent cisplatin and docetaxel chemotherapy with postoperative IMRT was safe and well tolerated, with acceptable acute and late toxicities. Moreover, the distant metastases control rates were encouraging, although loco-regional failure continued to be the primary mode of failure. Postoperative IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.