Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy for women with locally advanced carcinoma of the uterine cervix—Final results of a prospective phase II-study

Abstract

Objectives. To evaluate the efficacy and toxicity of ifosfamide and cisplatin administered concomitantly with low-dose rate brachyradiotherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell carcinoma (LASCC) or adeno/adenosquamous carcinoma of the uterine cervix. Methods. Sixty-two patients with primary uterine cervical cancer were enrolled between August 1999 and November 2004. The patients had to have FIGO-stage IB2 bulky to IVA disease, biopsy-proven squamous cell or adeno/adenosquamous carcinoma of the uterine cervix. The patients were to receive external radiotherapy (50 Gy in 25 fractions); ifosfamide 2 g/m 2 plus cisplatin 75 mg/m 2 was applied concomitantly during two low-dose rate brachyradiotherapy applications; the planned dose to point A was 85 Gy in total. After the completion of radiotherapy, i.e. external and concomitant chemobrachyradiotherapy, four cycles of consolidation chemotherapy with the same drug combination were to be administered. Results. The clinical complete response rate according to WHO-classification (assessed after the completion of the whole treatment procedures by gynecologic and radiologic evaluation and cervical biopsy) was 100%. After a median follow-up of 49 months (range 11–74 months), the recurrence-free and overall survival rates were 88.7%, respectively. The most frequent early toxicities were grade 3 and 4 leukopenias occurring in 25% and 11% of the cycles, respectively. Major delayed local complications occurred in 10 patients (16.1%). Conclusion. These results indicate that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy with the same drug combination is a highly efficacious and very promising treatment protocol for patients with locally advanced LASCC or adeno/adenosquamous carcinoma of the uterine cervix.