Skip to main content
SpringerLink
Log in

Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer

A retrospective single institution study

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

Given the lack of primary and secondary prevention programs and cancer awareness in general, cervical cancer remains one of the main causes of cancer-related death in developing countries, such as Bosnia and Herzegovina. Optimization of combinations of external radiation therapy (ERT), brachytherapy and chemotherapy is still needed to improve outcomes in the treatment of advanced cervical cancer.

Patients and methods

We retrospectively analyzed 48 consecutive patients with Fédération Internationale de Gynecologie et d’Obstetrique (FIGO) 2009 stage IB2-IVA, who were treated with primary concomitant chemobrachyradiotherapy (CCBRT) and consolidation chemotherapy at the Department of Oncology, University Hospital Mostar, Bosnia and Herzegovina between December 2012 and June 2020. Patients were treated with ERT plus two cycles of concomitant chemobrachytherapy with ifosfamide and cisplatin and low-dose rate (LDR) brachytherapy followed by four cycles of consolidation chemotherapy at 3‑week intervals. We evaluated local control rate (LCR), disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and toxicity.

Results

After 45.5 months (interquartile range, IQR = 47 months) of median follow-up, 5‑year DFS was 72.8% (95% confidence interval. CI 59–78%), OS was 76.6% (95% CI 60–79%), and DSS was 88% (95% CI 71–86%) with acceptable toxicity. LCR was 94%.

Conclusion

Primary CCBRT and consolidation chemotherapy applied in standard clinical practice in the treatment of locally advanced cervical cancer (LACC) produce respectable outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8:e191–e203. https://doi.org/10.1016/S2214-109X(19)30482-6.

    Article  PubMed  Google Scholar 

  2. Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet. 2013;7:889–99. https://doi.org/10.1016/S0140-6736(13)60022-7.

    Article  Google Scholar 

  3. Ditzian LR, David-West G, Maza M, et al. Cervical cancer screening in low- and middle-income countries. Mt Sinai J Med. 2011;78:319–26. https://doi.org/10.1002/msj.20263.

    Article  PubMed  Google Scholar 

  4. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340:1154–61. https://doi.org/10.1056/NEJM199904153401503.

    Article  CAS  PubMed  Google Scholar 

  5. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137–43. https://doi.org/10.1056/NEJM199904153401501.

    Article  CAS  PubMed  Google Scholar 

  6. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340:1144–53. https://doi.org/10.1056/NEJM199904153401502.

    Article  CAS  PubMed  Google Scholar 

  7. 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;17:1339–48. https://doi.org/10.1200/JCO.1999.17.5.1339.

    Article  CAS  PubMed  Google Scholar 

  8. Peters WA 3rd, Liu PY, Barrett RJ 2nd, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–13. https://doi.org/10.1200/JCO.2000.18.8.1606.

    Article  CAS  PubMed  Google Scholar 

  9. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–12. https://doi.org/10.1200/JCO.2008.16.4368.

    Article  CAS  PubMed Central  Google Scholar 

  10. Todo Y, Watari H. Concurrent chemoradiotherapy for cervical cancer: background including evidence-based data, pitfalls of the data, limitation of treatment in certain groups. Chin J Cancer Res. 2016;28:221–7. https://doi.org/10.21147/j.issn.1000-9604.2016.02.10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. National Comprehensive Cancer Network. Cervical cancer. 2021. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed 30 Dec 2020.

  12. Wong LC, Ngan HY, Cheung AN, et al. Chemoradiation and adjuvant chemotherapy in cervical cancer. J Clin Oncol. 1999;17:2055–60. https://doi.org/10.1200/JCO.1999.17.7.2055.

    Article  CAS  PubMed  Google Scholar 

  13. Tang J, Tang Y, Yang J, Huang S. Chemoradiation and adjuvant chemotherapy in advanced cervical adenocarcinoma. Gynecol Oncol. 2012;125:297–302. https://doi.org/10.1016/j.ygyno.2012.01.033.

    Article  PubMed  Google Scholar 

  14. Vrdoljak E, Prskalo T, Omrcen T, et al. Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix: results of a phase II study. Int J Radiat Oncol Biol Phys. 2005;61:824–9. https://doi.org/10.1016/j.ijrobp.2004.06.248.

    Article  CAS  PubMed  Google Scholar 

  15. Petrić Miše B, Boraska Jelavić T, Strikic A, et al. Long follow-up of patients with locally advanced cervical cancer treated with concomitant chemobrachyradiotherapy with cisplatin and ifosfamide followed by consolidation chemotherapy. Int J Gynecol Cancer. 2015;25:315–9. https://doi.org/10.1097/IGC.0000000000000336.

    Article  PubMed  Google Scholar 

  16. World Medical Association. World medical association declaration of helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4. https://doi.org/10.1001/jama.2013.281053.

    Article  CAS  Google Scholar 

  17. National Cancer Institute. NCI funded research portfolio. 2020. http://fundedresearch.cancer.gov/nciportfolio/. Accessed 30 Dec 2020.

  18. Choi CH, Lee JW, Kim TJ, et al. Phase II study of consolidation chemotherapy after concurrent chemoradiation in cervical cancer: preliminary results. Int J Radiat Oncol Biol Phys. 2007;68:817–22. https://doi.org/10.1016/j.ijrobp.2006.12.038.

    Article  CAS  PubMed  Google Scholar 

  19. Zhang MQ, Liu SP, Wang XE. Concurrent chemoradiotherapy with paclitaxel and nedaplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix: preliminary results of a phase II study. Int J Radiat Oncol Biol Phys. 2010;78:821–7. https://doi.org/10.1016/j.ijrobp.2009.08.069.

    Article  PubMed  Google Scholar 

  20. Mahasittiwat P, Leumwananonthachai N, Setakornnukul J, et al. Phase II consolidation chemotherapy with ifosfamide and cisplatin in locally advanced squamous cell carcinoma of the cervix uteri. Int J Radiat Oncol Biol Phys. 2011;81:452. https://doi.org/10.1016/j.ijrobp.2011.06.969.

    Article  Google Scholar 

  21. Dueñas-González A, Zarbá JJ, Patel F, et al. Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol. 2011;29:1678–85. https://doi.org/10.1200/JCO.2009.25.9663.

    Article  CAS  PubMed  Google Scholar 

  22. Tangjitgamol S, Tharavichitkul E, Tovanabutra C, et al. A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial. J Gynecol Oncol. 2019;30:e82. https://doi.org/10.3802/jgo.2019.30.e82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Lorvidhaya V, Chitapanarux I, Sangruchi S, et al. Concurrent mitomycin C, 5‑fluorouracil, and radiotherapy in the treatment of locally advanced carcinoma of the cervix: a randomized trial. Int J Radiat Oncol Biol Phys. 2003;55:1226–32. https://doi.org/10.1016/s0360-3016(02)04405-x.

    Article  CAS  PubMed  Google Scholar 

  24. Jelavić TB, Miše BP, Strikic A, Ban M, Vrdoljak E. Adjuvant chemotherapy in locally advanced cervical cancer after treatment with concomitant chemoradiotherapy—room for improvement? Anticancer Res. 2015;35:4161–5.

    PubMed  Google Scholar 

  25. Datta NR, Stutz E, Liu M, et al. Concurrent chemoradiotherapy vs. radiotherapy alone in locally advanced cervix cancer: a systematic review and meta-analysis. Gynecol Oncol. 2017;145:374–85. https://doi.org/10.1016/j.ygyno.2017.01.033.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank patients who participated in this study. The authors also want to thank Žarko Bajić for the help in statistical data analysis.

Author information

Authors and Affiliations

  1. Department of Oncology, University Clinical Hospital Mostar, Bijeli brijeg bb, 88000, Mostar, Bosnia and Herzegovina

    Krešimir Tomić MD, Gordana Berić Jozić, Ana Parić & Inga Marijanović

  2. Medical Physics and Radiation Protection Office, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina

    Ivan Lasić

  3. Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina

    Dragan Soldo

  4. Department of Oncology, University Hospital Split, School of Medicine Split, Split, Croatia

    Eduard Vrdoljak

Authors
  1. Krešimir Tomić MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gordana Berić Jozić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana Parić
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inga Marijanović
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ivan Lasić
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dragan Soldo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eduard Vrdoljak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KT contributed to the design of the study, data collection, data analysis, writing and manuscript revision. EV contributed to the design of the study, data analysis, writing and manuscript revision. GBJ and AP contributed to the data collection, data analysis and manuscript revision. IM and DS contributed to the data analysis and manuscript revision. IL performed the statistical analyses. All co-authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Krešimir Tomić MD.

Ethics declarations

Conflict of interest

K. Tomić, G. Berić Jozić, A. Parić, I. Marijanović, I. Lasić, D. Soldo and E. Vrdoljak declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tomić, K., Berić Jozić, G., Parić, A. et al. Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer. Wien Klin Wochenschr 133, 1155–1161 (2021). https://doi.org/10.1007/s00508-021-01958-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-021-01958-0

Keywords

Search

Navigation