This study evaluated the potential value of chemoradiotherapy (CRT) in preventing treatment failures (TF) and improving survivals in cervical cancer (CC) associated with high risk prognostic factors (HRPFs) after primary treatment (PT) of radiotherapy (RT).
Cervical cancer patients treated with radiotherapy or chemoradiotherapy and followed at YUMC from 1976 to 1989 were evaluated for the treatment outcomes and also the toxicities of chemotherapy (CT) done prior to RT in CRT group.
and also the toxicities of chemotrherapy (CT) done prior to RT in CRT group.
HRPFs such as stages III and IV, small cell, adeno-and adenosquamous carcinoma, lesion size > 4.0 cm, stage I or II with respective lesion size _>4.0 cm, or evidence of lymph node metastasis on lymphography were selected by statistically analyzing the 386 CC cases primarily treated with RT alone at YUMC from 1976 to 1984.
CRT where induction CT (ICT) is instituted prior to conventional RT was subsequently given to the 113 CC patients with at least one of these HRPFs. Two to 3 courses of ICT were administered, each at intervals of about 3 weeks, and a total of 312 cycles was administered. For squamous cell carcinomas, cisplatin (DDP), 100 Mg/M2 N infusion was followed immediately by 5-fluorouracil (5FU), 100 mg/m2/day as a 24-hour IV infusion for 5 days. For adenocarcinomas, DDP 70 mg/m2 IV infusion on day 1 was followed by cytoxan (C) 250 mg/m2 on day 2, and adriamycin (A) 45 mg/m2 on day 3.
In 113 cases treated with CRT the overall response rate (RR) to ICT prior to RT was 86.7 % (98 cases), complete response (CR) and partial response 26.5 % (30 cases) and 60.2 % (68 cases ) respectively, and the CR rate after subsequent RT was 92.9 /o (105 cases). The 5 year cumulative survival rate (CSR) was lower in cases with lesion size 4 cm or more than those with lesion size less than 4 cm (P < 0.05), however, the differences in 5 year CSR according to the presence or absence of other 4 HRPFs in CRT group were not statistically significant.
Comparison of CSR of these patients according to each of these 5 HRPFs in above order was 69.1 %, 68.1 %, 67.2 %,78.3 % and 79.5 /o after CRT and 57.4 %,54.5 %,53.0 %, 48.0 % and 48.8 % after RT alone; the CSR in the CRT group were all significantly higher than those of the RT group.
Drug toxicities were present as nausea, vomiting, and alopecia in all 312 cycles with varying degree of manifestation, and leukopenia, granulocytopenia, anemia, thrombocytopenia, hepatotoxicity, nephrotoxicity, and hypomagnesemia were seen in 46.5 %, 35.9 %, 20.8 %, 8.3 %, 53.2 %, 47.1 %, 55.4 % respectively. These toxicities resulted in drug treatment schedule changes in 191 cycles (61.2 %) given ICT; in 92, by delaying further durg administration; in 67, by stopping schedule and in 32, by reducing the dosage. However there was no treatment-related death, and mostly they showed abnormal laboratory findings without clinical symptoms, and fully recovered after the discontinuation or completion of the ICT with no significant effect on the subsequent radiotherapy.
The study´s results imply that ICT may be effective adjunct to PT with RT to reduce TF in patients with CCs aasociated with the described HRPFs, and the number of optimal courses to significantly improve prognosis while minimizing toxicity needs to be determined.
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