Abstract
BackgroundCisplatin and gemcitabine combined with conventional radiation therapy in the treatment of cervical cancer patients results in a favorable outcome but with excess toxicity. The purpose of this study was to evaluate the toxicity profile of dual chemotherapy and highly conformal external beam radiotherapy with image guided adaptive brachytherapy.MethodsSeventeen patients with cervical carcinoma FIGO stage IB2–IIIB were treated with curative intent between 2011 and 2015. A total dose of 50.4 Gy was prescribed to the elective pelvic nodal volume. Patients with 18FDG-PET/CT positive lymph nodes (n = 15; 83.3%) received an additional boost to a total dose of 62 Gy. Chemotherapy prescription goals were: concomitant during 5 weeks of external beam radiotherapy (EBRT) 40 mg/m2 cisplatin and 125 mg/m2 gemcitabine, followed by adjuvant chemotherapy from week 10 (2 cycles 50 mg/m2 cisplatin and 1000 mg/m2 gemcitabine). EBRT was followed by 3–4 fractions (6 Gy per fraction) of intrauterine image guided adaptive brachytherapy. Toxicities were graded according to the common terminology criteria for adverse events (CTCAE v 4.0).ResultsOne (6%) patient developed acute grade 3 diarrhea. We did not record any other acute or late gastrointestinal or urogenital toxicity higher that grade 3. Most common acute hematological toxicity was anemia grade 2 recorded in 10 (59%) patients. There was only one case of grade 3 neutropenia (6%). The number of patients that received the complete chemotherapy regimen was gradually declining during the course of therapy. From week 2 to 5, gemcitabine was omitted in 4 (24%),7 (41%), 8 (47%), and 12 (71%) patients respectively, similarly, cisplatin was omitted in 2 (12%),3 (18%),1 (6%) and 7 (41%) patients respectively. Adjuvant chemotherapy was omitted in 8 patients (47%). During a median follow-up time of 20 months (5 to 63 months) 6 (35%) patients developed disease relapse with 5 (29%) of them in the form of systemic disease.ConclusionsIn contrast to previous findings cisplatin and gemcitabine in combination with highly conformal radiation therapy seems to have an acceptable toxicity profile. Further studies are needed to determine the optimal dosage of the proposed therapy concept.
Highlights
Cisplatin and gemcitabine combined with conventional radiation therapy in the treatment of cervical cancer patients results in a favorable outcome but with excess toxicity
The goal of this study was to evaluate early toxicity of doublet concomitant chemotherapy followed by two adjuvant cycles, with dose escalated volumetric modulated external beam radiotherapy followed by intrauterine image guided adaptive brachytherapy (IGABT)
Patients Patients with histologically confirmed cervical cancer, Federation of Obstetrics and Gynecology (FIGO) stage IBI to IVA, treated with intensity modulated radiotherapy (IMRT) and concomitant combined chemotherapy with cisplatin and gemcitabine at the Bern University Hospital Department of Radiation Oncology were included in this retrospective study according to the institutional ethical standards
Summary
Cisplatin and gemcitabine combined with conventional radiation therapy in the treatment of cervical cancer patients results in a favorable outcome but with excess toxicity. The standard therapeutic approach for patients with loco-regionally advanced cervical cancer is combined radio-chemotherapy (RCT). Even though the outcome of RCT is better than that of radiation alone, the combined regimen is associated with a higher incidence of side effects while distant disease control and overall survival remains unsatisfactory [1, 2]. Rapid advancements in the radiation delivery technology and techniques as well as cancer imaging were achieved. These changes are well mirrored in a significantly improved therapeutic ratio of intensity modulated radiotherapy (IMRT) for various tumor entities, including cervical cancer [4]. It is possible to treat lymph node metastases using dose escalated radiotherapy without significant toxicity and modern image guided adaptive brachytherapy (IGABT) results in local control higher than 90% [7]
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