Distribution of platinum in the female genital tract and efficacy of radiotherapy combined with transcatheter arterial infusion of cisplatin for locally advanced stage IIIb carcinoma of the uterine cervix

Abstract

The current main treatment for locally advanced stage III/IV cervical cancer involves chemoradiotherapy. In this study, we investigated the distribution of platinum in the female genital tract by intra-arterial infusion of platinum (carboplatin 150 mg) during surgery and examined the therapeutic effects of radiotherapy with transcatheter arterial infusion (TAI) of cisplatin for locally advanced carcinoma of the uterine cervix. From January 1991, we randomly selected 26 patients with locally advanced stage IIIb cervical cancer to receive radiotherapy combined with TAI of 120 mg/body cisplatin twice a month at an interval of 4 weeks. Radiotherapy routinely involved 50 Gy of external beam irradiation to the whole pelvis and 12-24 Gy (point A dose) of intracavitary irradiation using a remote afterloading system. The mean platinum concentration in the cervical cancer was 1.77 microg/g wet tissue (wt) and high value, but the genital tract also contained the same platinum concentration. The platinum concentration in each regional lymph node was 1.10-1.48 microg/g wt, and its level of platinum was equal to that in the female genital tract. The effective histologic response rate was 88.5% (23/26). The median follow-up period was 38 months. The cumulative survival rate was 74.0%. Serious acute adverse reactions interfering with treatment were not observed. Based on these results, intra-arterial infusion of platinum produced a therapeutic effect on the primary cervical cancer site and the other parts of the female genital tract. We concluded that radiotherapy with TAI of cisplatin achieved superior therapeutic efficacy in locally advanced stage IIIb cervical cancer.