Concomitant chemo-radiotherapy with continuous infusion cisplatin and 5-fluoruracil in locally advanced cervical carcinoma (LACC): A single institution experience

Abstract

5073 Background: The primary aim of this analysis was to evaluate the resecability of LACC (stage IIA-IIIB) and the relationship between downstaging, progression-free-survival (PFS) and overall survival (OS) after neoadjuvant concomitant chemo-radiotherapy (CT-RT). Secondary aim was the assessment of activity and tolerability of such approach. Methods: Pts affected by LACC were planned to receive 50.4 Gy external beam RT (EBRT, boost included) plus concomitant CT with cisplatin (DDP) 5 mg/m2/day i.v. and 5-fluorouracil (5FU) 200 mg/m2/day i.v., day 1–5, for scheduled 5 weeks. After restaging, patients not suitable for curative resection were treated with additional 25 Gy EBRT. Scheduled surgical procedures were radical hysterectomy plus pelvic lymphadenectomy (PIVER II/III), according to clinical response. Results: Forty-nine pts with LACC referred to our Institution; pts characteristics: median age 55 (range 32–78); stage IIA/IIB/IIIA/IIIB 3pts/34pts/2pts/9pts; squamous cell LACC/adenocarcinoma 45/4. Thirty-two pts (65.3%) received 4–5 weeks of concurrent CT-RT (median RT dose 50.4 Gy, range 46–57.6) and underwent surgical resection. Twelve pts obtained CR (37.4%, 95% CI 20.7–54.3), 14 pts PR (43.8%, 95% CI 26.6–60.9), and 6 pts NC (18.8%, 95% CI 5.2–32.3). Seventeen pts (34.7%) received additional 2–3 weeks of concurrent CT-RT (median RT dose 25 Gy) without surgery. Of these, 3 pts had RC (17.6%, 95% CI 0–35.8), 6 pts PR (35.3%, 95% CI 12.6–58), 4 pts NC (23.5%, 95% CI 3.4–43.7), 3 pts PD (17.6%, 95% CI 0–35.7), and 1 pts NV. No CTC Grade 4 toxicity was observed; only 3 pts had G3 diarrhea. At a median follow-up of 18 months (range 3–84), 5-yrs-PFS in all pts was 60.5%, and 5 yrs-OS 56.9%. Five-yrs PFS and survival rate were significantly greater in pts undergone surgery (respectively p=0.03 and p=0.0001). Conclusions: Neoadjuvant concurrent CT-RT is tolerable, active and affect resecability owing to tumor shrinking. Moreover, the data seems to indicate that curative surgery improves 5-yrs OS. No significant financial relationships to disclose.