Journal Article

Chemoradiation in cervical cancer with cisplatin and high-dose rate brachytherapy combined with external beam radiotherapy: Results of a phase-II study

STRAUSS, Hans-Georg, HAENSGEN, Gabriele, KOELBL, Heinz, KUHNT, Thomas, PUSCHMANN, Daniela, PIGORSCH, Steffi, DUNST, Juergen, LABAN, Cornelia

2002

Overview

In 1999, five randomized studies demonstrated that chemoradiation with cisplatin and low-dose rate (LDR) brachytherapy has a benefit in locally advanced cervical cancer and for surgically treated patients in high-risk situations. We evaluated the safety and efficacy of concomitant chemoradiation with cisplatin and high-dose rate (HDR) brachytherapy in patients with cervical cancer. 27 patients were included in our phase-II trial: 13 locally advanced cases (group A) and 14 adjuvant-therapy patients in high-risk situations (group B). A definitive radiotherapy was performed with 25 fractions of external beam therapy (1.8 Gy per fraction/middle shielded after eleven fractions). Brachytherapy was delivered at HDR schedules with 7 Gy in point A per fraction (total dose 35 Gy) in FIGO Stages IIB-IIIB. The total dose of external and brachytherapy was 70 Gy in point A and 52-54 Gy in point B. All patients in stage IVA were treated without brachytherapy. Adjuvant radiotherapy was performed with external beam radiotherapy of the pelvis with 1.8 Gy single-dose up to 50.4 Gy. Brachytherapy was delivered at HDR schedules with two fractions of 5 Gy only in patients with tumor-positive margins or tumor involvement of the upper vagina. The chemotherapeutic treatment schedule provided six courses of cisplatin 40 mg/m2 weekly recommended in the randomized studies GOG-120 and -123. A total of 18/27 patients (66.7%) completed all six courses of chemotherapy. Discontinuation of radiotherapy due to therapy-related morbidity was not necessary in the whole study group. G3 leukopenia (29.6%) was the only relevant acute toxicity. There were no differences in toxicity between group A and B. Serious late morbidity occurred in 2/27 patients (7.4%). 12/13 patients (92.3%) with IIB-IVA cervical cancer showed a complete response (CR). 13/14 adjuvant cases (92.8%) are free of recurrence (median follow up: 19.1 months). Concomitant chemoradiation with cisplatin 40 mg/m2 weekly x 6 using HDR brachytherapy represents a promising treatment of cervical cancer with an acceptable toxicity.

• Publisher: Springer,Springer Nature B.V
• Subject: Adenocarcinoma - drug therapy / Adenocarcinoma - pathology / Adenocarcinoma - radiotherapy / Adenocarcinoma - surgery / Adult / Aged / Antineoplastic agents / Biological and medical sciences / Brachytherapy / Cancer therapies / Carcinoma, Adenosquamous - drug therapy / Carcinoma, Adenosquamous - pathology / Carcinoma, Adenosquamous - radiotherapy / Carcinoma, Adenosquamous - surgery / Carcinoma, Squamous Cell - drug therapy / Carcinoma, Squamous Cell - pathology / Carcinoma, Squamous Cell - radiotherapy / Carcinoma, Squamous Cell - surgery / Cervical cancer / Chemotherapy / Chemotherapy, Adjuvant / Cisplatin - administration & dosage / Combined Modality Therapy / Combined treatments (chemotherapy of immunotherapy associated with an other treatment) / Female / Follow-Up Studies / Humans / Hysterectomy / Medical sciences / Middle Aged / Neoplasm Staging / Pharmacology. Drug treatments / Radiation therapy / Radiation-Sensitizing Agents - administration & dosage / Radiotherapy, Adjuvant / Uterine Cervical Neoplasms - drug therapy / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - radiotherapy / Uterine Cervical Neoplasms - surgery