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Concomitant Radiochemotherapy of Cervical Cancer

Is It Justified to Reduce the Dosage of Cisplatin?

Radiochemotherapie des Zervixkarzinoms. Kann die Cisplatindosis reduziert werden?

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To review the experiences regarding the therapeutic response and side effects of concomitant radiochemotherapy of cervical cancer carried out with different cisplatin doses.

Patients and Methods:

At the Municipal Center for Oncoradiology, Budapest, Hungary, 92 patients with cervical cancer were treated with concomitant radiochemotherapy in the period between July 2002 and March 2007. The total dose of high-energy external radiation (megavoltage) treatment was 50.4 Gy with a fraction dose of 1.8 Gy on the small pelvis. Before irradiation, cisplatin 40 mg/m2, 30 mg/m2, or 20 mg/m2 was administered once a week.


In 17 cases, the cisplatin dose was 30 mg/m2; during radiochemotherapy the number of cisplatin treatments was equal to or more than four in 14 patients (82%). After administering 40 mg/m2 cisplatin to 64 patients, chemotherapy in four or more treatments could only be applied in 37 cases (58%). Eleven patients received cisplatin at the dose of 20 mg/m2; in ten (91%) of them, the number of treatments was four or more. By comparing the side effects, it can be stated that hematologic side effects (mostly leukopenia) grade 3 occurred in 12% of the patients receiving cisplatin 30 mg/m2, and grade G3–4 in 16% of the 40-mg/m2 cisplatin group. For cisplatin 30 mg/m2, 82% of hematologic side effects were in the G1 range. There was no significant difference between the 20- and 30-mg/m2 regimens. As for the gastrointestinal toxicity, similar side effects grade 1 were detected, which occurred in 58% and 38% of the patients receiving 30 mg/m2 and 40 mg/m2, respectively.


On the basis of a detailed analysis, the correlation between the number of treatments, the therapeutic and the side effects could be verified. In the course of dose reduction, there was no significant difference when comparing the results of therapy, however, the quality of life was better if cisplatin 30 mg/m2 was administered instead of 40 mg/m2. If cisplatin 20 mg/m2 was given, the results were significantly worse. On the basis of the own results, it can be stated that the optimal weekly dose of cisplatin is 30 mg/m2.


Reduktion der Cisplatindosis bei der Radiochemotherapie des Zervixkarzinoms in Abhängigkeit von therapeutischen Effekten und Nebenwirkungen.

Patienten und Methodik:

Zwischen Juli 2002 und März 2007 erhielten 92 Patientinnen mit Zervixkarzinom am Städtischen Onkoradiologischen Zentrum, Budapest, Ungarn, eine Radiochemotherapie. Das kleine Becken wurde mit einer Gesamtdosis von 50,4 Gy (28 Fraktionen à 1,8 Gy) bestrahlt. Vor der Radiotherapie wurde Cisplatin wöchentlich in einer Dosierung von einmal 40 mg/m2, 30 mg/m2 oder 20 mg/m2 Körperoberfläche gegeben.


17 Patientinnen erhielten zusätzlich zur Radiotherapie 30 mg/m2 Cisplatin, 14 von ihnen (82%) tolerierten vier oder mehr Cisplatinapplikationen. In der Gruppe mit 40 mg/m2 Cisplatin vertrugen nur 37 Patientinnen (58%) vier oder mehr Cisplatinapplikationen. In der dritten Gruppe (elf Patientinnen) erhielten zehn Patientinnen (91%) vier oder mehr Cisplatinbehandlungen mit 20 mg/m2/Woche. Beim Vergleich der Nebenwirkungen konnte festgestellt werden, dass hämatologische Nebenwirkungen (meist Leukopenie) Grad 3 bei 12% der Gruppe mit 30 mg/m2 und Grad 3–4 bei 16% der Gruppe mit 40 mg/m2 Cisplatin auftraten. 82% der hämatologischen Nebenwirkungen unter 30 mg/m2 Cisplatin wurden als Grad 1 eingestuft. Es konnte kein Unterschied zwischen den Schemata mit 20 und 30 mg/m2 gefunden werden. Bezüglich der gastrointestinalen Toxizität wurden ebenfalls Grad-1-Nebenwirkungen beobachtet, die bei 30 mg/m2 in 58% und bei 40 mg/m2 in 38% auftraten.


Die optimale wöchentliche Dosierung für Cisplatin beträgt 30 mg/m2. Zwischen der kumulativen Cisplatindosis und der therapeutischen Effektivität besteht eine deutliche Korrelation. 40 mg/m2 erhöhten die therapeutische Wirkung nicht. Die Lebensqualität der Patientinnen war aber bei kleineren Dosen besser. 20 mg/m2 Cisplatin ergaben signifikant schlechtere Resultate.

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Correspondence to Árpád Mayer MD.

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Patyánik, M., Nemeskéri, C., Póti, Z. et al. Concomitant Radiochemotherapy of Cervical Cancer. Strahlenther Onkol 185, 582–587 (2009).

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