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
- 7 Downloads
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.
- 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.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.
- 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
- 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