Acute and long-term toxicity in patients undergoing induction chemotherapy followed by thermoradiotherapy for advanced cervical cancer

Figures & data

Table 1. Patient and tumor characteristics of the locally advanced cervical cancer group (N = 105).^*

	N (%)
Age, years
Median (range)	45 (22–79)
BMI
Mean (± SD)	26.0 (5.9)
Clinical performance status (WHO)
0–1	89 (87.3)
2	5 (4.9)
Unknown	11 (10.4)
Histological type
Squamous cell carcinoma	90 (86)
Adenocarcinoma	7 (6.7)
Adenosquamous carcinoma	2 (1.9)
Other^a	4 (3.9)
Unknown	2 (1.9)
Comorbidities
Diabetes mellitus	7 (6.8)
Hypertension > 145/90 mm/Hg (with use of medication)	14 (13.4)
Peripheral arterial disease	3 (2.9)
Smoking
Current smoker	44 (41.9)
Past smoker	8 (7.6)
Never smoker	31 (29.5)
Unknown	22 (21.0)
Use of anticoagulants
Yes	6 (5.7)
No	99 (94.3)
Thrombosis in history
No	96 (91.4)
Venous thrombo-embolic (PE, DVT)	4 (3.8)
Arterial embolic (CVA/TIA, peripheral arterial insufficiency, Myocardial infarction)	5 (4.8)
Tumor size (cm)
Median	6.0 (2.6–11.5)
<6	44 (42)
6–7	35 (33)
>7	20 (19)
Unknown	6 (6)
Hydronephrosis at presentation
Yes	29 (28)
No	76 (72)
Lymph nodes (at highest level)
No suspicious nodes	15 (13.3)
Internal/external iliacal artery	31 (29.5)
Common iliacal artery	15 (14.3)
Para-aortic	33 (31.4)
Renal artery	8 (7.6)
Supraclavicular	3 (2.9)

Notes: PE: pulmonary embolism; DVT: deep venous thrombosis; CVA: cerebrovascular accident; TIA: transient ischemic attack.

*7 recurrent tumors, treated with surgery only for the primary disease.

^aOther histology types: small cell neuroendocrine, clear cell, endometrioïd and gastric type mucinous adenocarcinoma.

Figure 1. Reasons for modification of chemotherapy. AKI: acute kidney injury; TEE: thrombo-embolic event; hypoMg: hypomagnesemia; hypoCa: hypocalcemia.

Table 2. Radiological response after three or six cycles of neo-adjuvant chemotherapy (NAC) and at the end of treatment, using RECIST criteria.

Response	After NAC N(%)	After ending treatment N (%)
Complete (CR)	2 (1.9)	86 (81.9)
Partial (PR)	91 (86.7)	11 (10.5)
Progression (PD)	0	6 (5.7)
Stable (SD)	10 (9.5)	2 (1.9)
Missing	2 (1.9)	0

Notes: NAC: neo-adjuvant chemotherapy; CR: complete response; PR: partial response; PD: progressive disease; SD: stable disease.

Table 3. Acute and chronic toxicity scored with CTCAE.^a

Acute toxicity	Grade 1	Grade 2	Grade 3	Grade 4
Hematological
Leukocytopenia	6	38	23	4
Neutropenia	0	19	29	27
Thrombocytopenia	44	10	13	7
Anaemia	11	64	23	0
Renal toxicity
Creatinine	28	9	9	0
Vascular toxicity	1	3	14	3
Chronic toxicity
Renal toxicity
Before start of RT^b	–	36	1	0
End of RT^c		38	0	0
Last available (1 month-16 years)		35	1^d	1^d

Note: Grade 5 toxicity (death) did not occur.

^aPeriod: acute toxicity from start of chemotherapy till before start of radiotherapy. The toxicity grades were defined based on the peak value during chemotherapy. RT = Radiotherapy

^b±10 weeks after chemotherapy.

^c5–6 weeks after start of radiotherapy.

^dCTCAE, grade 1 is defined as eGFR between 90 and 60, but normal creatinine laboratory values are displayed as > 60 ml/min.

Data availability statement

The data supporting the findings of this study are available on request from the corresponding author.