A Study on the Response of Concurrent Chemoradiation with Gemcitabine Versus Cisplatin in Patients with Locally Advanced Cervical Carcinoma

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Introduction Cervical cancer is the most common cause of cancer death in women. Currently, platinum-based concurrent chemoradiation therapy is the standard of care for locally advanced cervical cancer but treatment results are disappointing, particularly for women with bulky tumors. Several non-platinum-based agents with concurrent chemoradiation have been evolved to improve this result. Objective To compare the response between concurrent chemoradiation with gemcitabine and cisplatin followed by intracavitary radiotherapy in patients with locally advanced cervical carcinoma. Material and methods This was a quasi-experimental study, where 66 patients with untreated invasive squamous cell carcinoma of the cervix of stage IIB to stage IVA were enrolled from the Radiation Oncology Department of Rajshahi Medical College Hospital from April 2019 to March 2020. The duration of the study was 2 years. In each arm 33 patients were assigned to receive 150 mg/m² of gemcitabine (arm A) or received 40mg/m2 of cisplatin (arm B) weekly along with external beam radiation therapy (EBRT). EBRT dose was 50 Gy in 25 daily fractions followed by intracavitary radiotherapy (ICRT) of 21 Gy in 3 fractions. Results The mean age was 45.4 years & 47.3 years in arm A & B respectively. Most patients were in the stage IIB group (59.1% patients) and most were moderately differentiated (62.1% patients) in both arms. After 3 months of treatment, the complete response was found in 81.8% &72.7% of patients and partial response was seen in 12.1% & 18.2% of patients in arm A & B respectively (p=0.678). The grade 2 and 3 hematological toxicities (anemia, neutropenia, thrombocytopenia) were more common in arm A compared to arm B (p<0.05). The grade 2 and 3 proctitis & skin toxicity were higher in arm A & renal toxicity was higher in arm B (p=0.163). Conclusion Concurrent chemoradiation with gemcitabine can be used as an alternative to cisplatin when cisplatin is contraindicated. However, further large, randomized study is needed to reach any form of conclusion.