E. Rakovitch et al., ROLE OF MITOMYCIN-C IN THE DEVELOPMENT OF LATE BOWEL TOXICITY FOLLOWING CHEMORADIATION FOR LOCALLY ADVANCED-CARCINOMA OF THE CERVIX, International journal of radiation oncology, biology, physics, 38(5), 1997, pp. 979-987
Citations number
31
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To determine if the inclusion of mitomycin C (MMC) in chemora
diation protocols for locally advanced cervical cancer (LACC) signific
antly enhances the development of serious (Grade 3) late bowel toxicit
y (SLBT), Methods and Materials: The incidence of SLBT in 154 patients
with LACC entered in six consecutive chemoradiotherapy protocols betw
een February 1982 and June 1987 was determined. Fifty-four patients wh
o were treated with MMC, 5-fluorouracil (5-FU), and radiation were com
pared to 100 patients who received similar treatment without MMC. Univ
ariate and multivariate analyses assessed the effect of the following
parameters on the development of SLBT: (a) external beam dose, (b) rec
tal and rectosigmoid dose, (c) paraaortic radiation, (d) intracavitary
dose and dose rate, (e) volume of tissue irradiated to a total dose o
f 60 Gy, (f) International. Federation of Gynecology and Obstetrics st
age, (g) age, (h) number of courses of 5-FU, (i) previous abdominopelv
ic surgery, (j) split versus continuous radiation, and (k) administrat
ion of MMC. Results: The overall incidence of SLBT was 15.6%: 14 of 54
(26%) versus 10 of 100 (10%) for patients who did or did not receive
MMC, respectively (p = 0.009), Multivariate analysis revealed the admi
nistration of MMC as the only factor predictive for the development of
SLBT (p = 0.012, odds ratio = 3.15; 95% confidence interval 1.3-7.7),
A significant reduction in SLBT was observed with the elimination of
MMC from the chemoradiation protocols despite dose escalation of both
radiation and 5-FU. No increase in overall survival was observed in pa
tients receiving MMC, 5-FU, and radiation compared with 5-FU and radia
tion alone. Conclusion: The inclusion of MMC in these chemoradiation p
rotocols for LACC is associated with significant enhancement in seriou
s late bowel toxicity, (C) 1997 Elsevier Science Inc.