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
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.
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.
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.
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.
KeywordsCervical cancer Concurrent chemo-radiation Telecobalt LDR brachytherapy Shortening of overall treatment time Cisplatin versus cisplatin+paclitaxel
Compliance with Ethical Standards
Conflicts of interest
The authors declare that they have no conflict of interests.
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