A Prospective Study to Evaluate the Feasibility and Outcome of Completing Concurrent Chemo-radiation and Brachytherapy Within 4 Weeks Using Two Different Chemotherapy Regimens in Carcinoma Cervix

  • Sovan Sarang Dhar
  • Uday Pratap Shahi
  • Tejbali Singh
  • Anupam Kumar Asthana
  • Satyajit Pradhan
  • Lalit Mohan Aggarwal
  • Sunil Choudhary
  • Abhijit Mandal
  • Deepak Kumar
Original Article
  • 7 Downloads

Abstract

Purpose

A prospective study was performed to assess the feasibility and outcome of completing concurrent chemo-radiotherapy (CCRT) in ≤ 4 weeks in cervical cancer patients using combination of paclitaxel and cisplatin as weekly regimen versus weekly cisplatin as concurrent chemotherapy.

Methods

Forty patients of mostly locally advanced stage were prospectively allocated to receive either weekly cisplatin (40 mg/m2) [arm A] or weekly paclitaxel (50 mg/m2) and cisplatin (30 mg/m2) [arm B]. External Beam Radiotherapy [EBRT] in both arms given was 45 Gy/20 fractions/5 fractions per week (using conventional technique, Co60 teletherapy), intracavitary radiotherapy 30 Gy to point A (using LDR in a single setting) in between EBRT fractions, starting after completion of 10 fractions of EBRT.

Results

Treatment of 65% of arm B and 70% of arm A patients could be completed by 4 weeks. At a median follow-up of 24 months, 85% patients in each arm had complete loco-regional control, on intention to treat analysis. Thirty-month survival in the respective arms were 69 and 72.2%. Grade 3 acute toxicity varied between 10 and 15% in both arms. Grade-5 acute haematological toxicity was found in one patient (5%) of each arm. Difference between the two arms was statistically not significant for response, survival or toxicity.

Conclusion

Completing CCRT by 4 weeks is feasible with acceptable acute toxicity and encouraging outcome for carcinoma cervix. Concurrent weekly cisplatin + paclitaxel do not improve loco-regional control or survival as compared to weekly cisplatin alone at the cost of similar toxicity. Large sample study and long follow-up are needed to establish the same and identify late toxicities.

Keywords

Cervical cancer Concurrent chemo-radiation Telecobalt LDR brachytherapy Shortening of overall treatment time Cisplatin versus cisplatin+paclitaxel 

Notes

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interests.

References

  1. 1.
    IARC: International Agency for research on Cancer. Press release, latest World Cancer Statistics Global cancer burden rises to 14.1 million new cases in 2012; marked increase in breast cancers must be addressed. 2013, Dec 12 [cited 2017 Sep 4]. Available from https://www.iarc.fr/en/media-centre/pr/2013/pdfs/pr223_E.pdf.
  2. 2.
    ICMR: Indian Council of Medical Research. Press release, Over 17 lakh new cancer cases in India by 2020. 2016, Sep 9 [cited 2017 Sep 4]. Available from http://icmr.nic.in/icmrsql/archive/2016/7.pdf.
  3. 3.
    Dutta S, Biswas N, Muhkherjee G. Evaluation of socio-demographic factors for non-compliance to treatment in locally advanced cases of cancer cervix in a rural medical college hospital in India. Indian J Palliat Care. 2013;19(3):158–65.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Eifel PJ, Winter K, Morris 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(5):872–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a gynecologic oncology group and southwest oncology group study. J Clin Oncol. 1999;17(5):1339–1348CrossRefPubMedGoogle Scholar
  6. 6.
    Nugent EK, Case AS, Hoff JT, et al. Chemo-radiation in locally advanced cervical carcinoma: an analysis of Cisplatin dosing and other clinical prognostic factors. Gynecol Oncol. 2010;116:438–41.CrossRefPubMedGoogle Scholar
  7. 7.
    Monk BJ, Tian C, Rose PG, Lanciano R. Which clinical/pathologic factors matter in the era of chemo-radiation as treatment for locally advanced cervical carcinoma? Analysis of two Gynecologic Oncology Group (GOG) trials. Gynecol Oncol. 2007;105:427–33.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Song S, Rudra S. MD Hasselle (2013) The effect of treatment time in locally advanced cervical cancer in the era of concurrent chemoradiotherapy. Cancer. 2013;119:325–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Chufal KS, Rastogi M, Srivastava M, Pant MC, Bhatt MLB, Srivastava K. Concurrent chemoradiotherapy for locally advanced cervical cancer using gemcitabine: nonrandomized comparison of three sequential protocols. Cancer Ther. 2007;5:43–54.Google Scholar
  10. 10.
    Negi RR, Gupta M, Kumar M, Gupta MK, Seam R, Rastogi M. Concurrent chemo-radiation in locally advanced carcinoma cervix patients. J Cancer Res Ther. 2010;6(2):159–66.CrossRefPubMedGoogle Scholar
  11. 11.
    Jeyaseelan V, Pavamani SP, Ram TS, Thomas EM, Varghese SS, Viswanathan PN. Concurrent chemo-irradiation with weekly cisplatin and Paclitaxel in the treatment of locally advanced squamous cell carcinoma of cervix: a phase II study. J Cancer Res Ther. 2014;10(2):330–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Thakur P, Seam R, Gupta M, Gupta M. Prospective randomized study comparing concomitant chemoradiotherapy using weekly cisplatin & paclitaxel versus weekly cisplatin in locally advanced carcinoma cervix. Ann Transl Med. 2016;4(3):48.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Kirwan JM, Symonds P, Green JA, Tierney J, Collingwood M, Williams CJ. A systematic review of acute and late toxicity of concomitant chemo-radiation for cervical cancer. Radiother Oncol. 2003;68:217–26.CrossRefPubMedGoogle Scholar
  14. 14.
    Saibishkumar EP, Patel FD, Sharma SC. Results of a phase II trial of concurrent chemo-radiation in the treatment of locally advanced carcinoma of uterine cervix: an experience from India. Bull Cancer. 2005;92(1):E7–12.PubMedGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2018

Authors and Affiliations

  • Sovan Sarang Dhar
    • 1
    • 2
  • Uday Pratap Shahi
    • 2
  • Tejbali Singh
    • 3
  • Anupam Kumar Asthana
    • 2
  • Satyajit Pradhan
    • 2
  • Lalit Mohan Aggarwal
    • 2
  • Sunil Choudhary
    • 2
  • Abhijit Mandal
    • 2
  • Deepak Kumar
    • 2
    • 4
  1. 1.Department of RadiotherapyAll India Institute of Medical SciencesBhubaneswarIndia
  2. 2.Department of Radiotherapy and Radiation Medicine, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
  3. 3.Department of Bio-statistics, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
  4. 4.Department of RadiotherapyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations