TREATMENT OUTCOME AND TOXICITY OF NEOADJUVANT CHEMOTHERAPY FOLLOWED BY CONCOMITANT CHEMORADIOTHERAPY VERSUS CONCOMITANT CHEMORADIATION ALONE IN LOCALLY ADVANCED CERVICAL CARCINOMA: A COMPARATIVE STUDY
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i7.44947Keywords:
Keywords: Neoadjuvant chemotherapy, locally advanced, cervical cancer.Abstract
Objectives: This study intended to explore the outcome, and toxicities of neoadjuvant chemotherapy in addition to standard treatment concomitant chemoradiation in locally advanced cervix cancer.
Methods: Sixty-two (n=62) locally advanced cervical carcinoma patients were randomized into two arms: The controlled arm (30 patients) received concomitant chemoradiation with external beam radiation therapy of 50 Gy to the whole pelvis and Inj. Cisplatin (40 mg/m2/week) alone and the study arm (32 patients) received three cycles, neoadjuvant chemotherapy with Inj. Paclitaxel (175 mg/m2), and Inj. Cisplatin (75 mg/m2) at 3 weekly intervals, followed by concomitant chemoradiation with external beam radiation therapy (EBRT) of 50 Gy to whole pelvis and Inj. Cisplatin (40 mg/m2/week). Responses to treatment, toxicities, disease-free survival, and progression-free survival (PFS) were analyzed in both arms.
Results: Among the total of 62 patients, 30 were in the concomitant chemoradiation alone arm and 32 were in neoadjuvant chemotherapy followed by the concomitant chemoradiation arm. The median follow-up period was about 13 months. The tumor response in the form of complete or partial responses was equivalent in the two arms. The disease-free survival and the PFS were also comparable in both arms. The acute and the late toxicities were also comparable in the two arms.
Conclusions: This study showed that neoadjuvant chemotherapy with paclitaxel and cisplatin before definitive concomitant cisplatin-based chemoradiation can be used as an alternative in the management of locally advanced carcinoma of the cervix.
Downloads
References
Chauvergne J, Rohart J, Heron JF, Fargeot P, Berlie J. Randomized phase III trial of neoadjuvant chemotherapy and radiotherapy versus radiotherapy in stage IIB, III carcinoma of the cervix: A cooperative study of the French oncology centers. Proc Am Soc Clin Oncol 1988;7:136-44.
Tattersall MH, Ramirez C, Coppleson M. A randomized trial comparing platinum-based chemotherapy followed by radiotherapy versus radiotherapy alone in patients with locally advanced cervical cancer. Int J Gynecol Oncol 1992;2:244-51.
Kumar L, Kaushal R, Nandy M, Biswal BM, Kumar S, Kriplani A, et al. Chemotherapy followed by radiotherapy versus radiotherapy alone in locally advanced cervical cancer: A randomized study. Gynecol Oncol 1994;54:307-15. doi: 10.1006/gyno.1994.1215, PMID 7522200
Souhami L, Gil RA, Allan SE, Canary PC, Araújo CM, Pinto LH, et al. A randomized trial of chemotherapy followed by pelvic radiotherapy in stage IIIB carcinoma of the cervix. J Clin Oncol 1991;9:970-7. doi: 10.1200/JCO.1991.9.6.970, PMID 1709686
Sundfør K, Tropé CG, Högberg T, Onsrud M, Koern J, Simonsen E, et al. Radiotherapy and neoadjuvant chemotherapy for cervical carcinoma. A randomized multicenter study of sequential cisplatin and 5-fluorouracil and radiotherapy in advanced cervical carcinoma stage 3B and 4A. Cancer. 1996;77:2371-8. doi: 10.1002/(SICI)1097- 0142(19960601)77:11<2371:AID-CNCR28>3.0.CO;2-T, PMID 8635109
Tattersall MH, Lorvidhaya V, Vootiprux V, Cheirsilpa A, Wong F, Azhar T, et al. Randomized trial of epirubicin and cisplatin chemotherapy followed by pelvic radiation in locally advanced cervical cancer. Cervical cancer study group of the Asian oceanian clinical oncology association. J Clin Oncol 1995;13:444-51. doi: 10.1200/ JCO.1995.13.2.444, PMID 7844607
Herod J, Burton A, Buxton J, Tobias J, Luesley D, Jordan S, et al. A randomized, prospective, phase III clinical trial of primary bleomycin, ifosfamide, and cisplatin (BIP) chemotherapy followed by radiotherapy versus radiotherapy alone in inoperable cancer of the cervix. Ann Oncol 2000;11:1175-81. doi: 10.1023/a:1008346901733, PMID 11061615
Benedetti-Panici P, Greggi S, Colombo A, Amoroso M, Smaniotto D, Giannarelli D, et al. Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: Results from the Italian multicenter randomized study. J Clin Oncol 2002;20:179-88. doi: 10.1200/JCO.2002.20.1.179, PMID 11773168
Duenas-Gonzalez A, Lopez-Graniel C, Gonzalez-Enciso A, Mohar A, Rivera L, Mota A, et al. Concomitant chemoradiation versus neoadjuvant chemotherapy in locally advanced cervical carcinoma: Results from two consecutive phases II studies. Ann Oncol 2002;13:1212-9. doi: 10.1093/annonc/mdf196, PMID 12181244
McCormack M, Kadalayil L, Hackshaw A, Hall-Craggs MA, Symonds RP, Warwick V, et al. A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer. Br J Cancer 2013;108:2464-9. doi: 10.1038/ bjc.2013.230, PMID 23695016
Sugiyama T, Nishida T, Hasuo Y, Fujiyoshi K, Yakushiji M. Neoadjuvant intra-arterial chemotherapy followed by radical hysterectomy and/ or radiotherapy for locally advanced cervical cancer. Gynecol Oncol 1998;69:130-6. doi: 10.1006/gyno.1998.4976
Minagawa Y, Kigawa J, Irie T, Okada M, Kanamori Y, Terakawa N. Radical surgery following neoadjuvant chemotherapy for patients with stage IIIB cervical cancer. Ann Surg Oncol 1998;5:539-43. doi: 10.1007/BF02303647, PMID 9754763
Sardi J, Sananes C, Giaroli A, Maya G, Di Paola G. Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri. Gynecol Oncol 1990;38:486-93. doi: 10.1016/0090-8258(90)90096-4, PMID 1699851
Roberts KB, Urdaneta N, Vera R, Vera A, Gutierrez E, Aguilar Y, et al. Interim results of a randomized trial of mitomycin C as an adjunct to radical radiotherapy in the treatment of locally advanced squamous-cell carcinoma of the cervix. Int J Cancer 2000;90:206-23. doi: 10.1002/1097-0215(20000820)90:4<206:aid-ijc4>3.0.co;2-o, PMID 10993961
Smith HO, Jiang CS, Weiss GR, Hallum AV, Liu PY, Robinson WR, et al. Tirapazamine plus cisplatin in advanced or recurrent carcinoma of the uterine cervix: A Southwest oncology group study. Int J Gynecol Cancer 2006;16:298-305. doi: 10.1111/j.1525-1438.2006.00339.x, PMID 16445649
Hreshchyshyn MM, Aron BS, Boronow RC, Franklin EW, Shingleton HM, Blessing JA. Hydroxyurea or placebo combined with radiation to treat stage IIIB and IV cervical cancer confined to the pelvis. Int J Radiat Oncol Biol Phys 1979;5:317-22. doi: 10.1016/0360- 3016(79)91209-4, PMID 110744
Umesaki N, Fujii T, Nishimura R, Tanaka T, Nishida M, Fushiki H, et al. Phase II study of irinotecan combined with mitomycin-C for advanced or recurrent squamous cell carcinoma of the uterine cervix: The JGOG study. Gynecol Oncol 2004;95:127-32. doi: 10.1016/j. ygyno.2004.06.044, PMID 15385121
Verschraegen CF, Levy T, Kudelka AP, Llerena E, Ende K, Freedman RS, et al. Phase II study of irinotecan in prior chemotherapy-treated squamous cell carcinoma of the cervix. J Clin Oncol 1997;15:625-31. doi: 10.1200/JCO.1997.15.2.625, PMID 9053486
Schilder RJ, Blessing J, Cohn DE. Evaluation of gemcitabine in previously treated patients with non-squamous cell carcinoma of the cervix: A phase II study of the gynecology oncology group. Gynecol Oncol 2005;96:103-7. doi: 10.1016/j.ygyno.2004.09.027, PMID 15589587
Brewer CA, Blessing JA, Nagourney RA, McMeekin DS, Lele S, Zweizig SL. Cisplatin plus gemcitabine in previously treated squamous cell carcinoma of the cervix: A phase II study of the gynecologic oncology group. Gynecol Oncol 2006;100:385-8. doi: 10.1016/j. ygyno.2005.09.009, PMID 16271750
Perez CA, Grigsby PW. Adjuvant chemotherapy and irradiation in locally advanced squamous cell carcinoma of the uterine cervix. PPGO updates 1993;1:1-20.
Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: An update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol 2004;22:872-80. doi: 10.1200/JCO.2004.07.197, PMID 14990643
Published
How to Cite
Issue
Section
Copyright (c) 2022 DR. CHANDRIMA BANERJEE, DR. SAPTARSHI BANERJEE, DR. SHATARUPA DUTTA, DR. ANJAN BERA
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
