Email this article 
Post a Comment 
Concurrent pelvic radiation with weekly low-dose cisplatin and gemcitabine as primary treatment of locally advanced cervical cancer: A phase II study
Abstract
Purpose: This study was done to evaluate response, compliance and survival of weekly low dose cisplatin (20 mg/m2) and gemcitabine (125 mg/m2) concurrently with pelvic radiation as primary treatment of stage IIB-IIIB cervical cancer.
Methods: External radiation consisted of 50 Gy/25 fractions using 6-10 MV photon followed by 600 cGy boost to parametrium if it was still felt thickened. Then, intracavitary radiotherapy to deliver 60 Gy at point A. Chemotherapy consisted of gemcitabine at a dose of 125 mg/ m2 was given by i.v infusion over 30 minutes immediately after cisplatin 20 mg/ m2 weekly for 5 weeks during EBRT. Forty–five eligible patients received the treatment protocol.
Results: Toxicity was tolerable and manageable. No grade 4 toxicity while grade 3 was recorded in hematologic one only. In order of frequency; diarrhea, nausea and vomiting, and anemia (50%, 40%, 35.5%) were most common adverse events. Overall clinical response rate was 93.4% with pathological complete response of 62.2%. After median follow-up of 20 months, 2-year survival and progression-free survival rates were 90.5% and 81% respectively.
Conclusion: Weekly combination of low- dose cisplatin and gemcitabine given concurrently with pelvic radiotherapy in primary treatment of locally advanced cervical cancer resulted in a high response rate with a good compliance. Further exploration is needed for the use of this approach prior to incorporating it into routine clinical care through phase III clinical trial.
Keywords
Full Text:
PDFReferences
Ferlay J, Bray F, Pisani P, et al. Globocan 2002: Cancer Incidence, Mortality and Prevelance Worldwide. IARC Cancer Base No. 5, version 2.0.Lyon: IARC Press, 2004.
Park JH, Kim YS, Ahn SD, et al. Concurrent chemoradiotherapy or radiotherapy alone for locally advanced cervical cancer in elderly women. Tumori. 2010;96:959-65.
Green J, Kirwan J, Tierney J, et al. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database Syst Rev. 2005;CD002225.
Pattaranutaporn P, Thirapakawong C, Chansilpa Y, et al. Phase II study of concurrent gemcitabine and radiotherapy in locally advanced stage IIIB cervical carcinoma. Gynecol Oncol. 2001;81:404-7.
Zarbá JJ, Jaremtchuk AV, Gonzalez Jazey P, et al. A phase I-II study of weekly cisplatin and gemcitabine with concurrent radiotherapy in locally advanced cervical carcinoma. Ann Oncol. 2003;14:1285-90.
Umanzor J, Aguiluz M, Pineda C, et al. Concurrent cisplatin/gemcitabine chemotherapy along with radiotherapy in locally advanced cervical carcinoma: a phase II trial. Gynecol Oncol. 2006;100:70-5.
Mc Cormack M, Thomas H. A phase IB study of gemcitabine and concurrent radiotherapy in carcinoma of the cervix. Ann Oncol 2000;11:88.
Sirvastava N, Sahani K, Srivastave M. Comparative efficacy of cisplatin vs. gemcitabine as concurrent chemotherapy for untreated locally advanced cervical cancer: A randomized trail. Internet Journal of Medical Update 2007; 2:4-9.
Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events, Version 3 DCTD, NCI, NIH, DHHS, 2003. Available from http://ctep.cancer.gov/
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341-6.
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228-47.
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.
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.
Hernández P, Olivera P, Dueñas-Gonzalez A, et al. Gemcitabine activity in cervical cancer cell lines. Cancer Chemother Pharmacol. 2001;48:488-92.
Chumworathayi B, Suprasert P, Charoenkwan K, et al. Weekly versus three-weekly cisplatin as an adjunct to radiation therapy in high- risk stage I-IIA cervical cancer after surgery; a randomized comparison of treatment compliance. J Med Assoc Thai. 2005; 88:1483-92.
Chumworathayi B, Yuenyao P, Tangvorapongchai V, et al. Weekly gemcitabine and cisplatin concurrent with pelvic irradiation for primary therapy of cervical cancer: report of the first seven cases in Thaiwomen. Radiat Med. 2007; 25:474-9.
Khalil A, Shamseddine A, Geara F, et al. Concurrent chemo-radiotherapy for locally advanced cervical cancer: A prospective randomized trial comparing cis-platinum vs paclitaxel. J Clin Oncol. (ASCO Annual Meeting Proceedings) 2005; 23:5163
DOI: http://dx.doi.org/10.14319/ijcto.33.13
This work is licensed under a Creative Commons Attribution 3.0 License.
International Journal of Cancer Therapy and Oncology (ISSN 2330-4049)
© International Journal of Cancer Therapy and Oncology (IJCTO)
To make sure that you can receive messages from us, please add the 'ijcto.org' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.
Number of visits since October, 2013