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KMID : 0378019940370020039
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New Medical Journal
1994 Volume.37 No. 2 p.39 ~ p.47
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Effect of Chemotherapy before Primary Radiotherapy in the Treatment of Cervical Cancer
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Abstract
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Between September, 1989 and December, 1991, a program of induction chemotherapy for primary radiotherapy was employed to treat 32 women with advanced (stages II b?IVa) or early bulky (greater than 4cm) carcinoma of the uterine cervix. A retrospective study was done to determine the effects of neoadjuvant chemotherapy by reviewing charts in, 29 women evaluable for response. They had stage I in 4, stage II in 17, stage III in 6, stage IV in 2. 43 evaluable women of 48 women with radiotherapy alone were used as control. Chemotherapy regimen was ADP, 60mg/m2 IV on day 1, and 5-FU, 1000mg/m2/day IV infusion for 12 hours on days 1 to 5, which were administered every 3 weeks for 2-3 cycles. Radiotherapy was underwent usually 5040 rads given as 180 rads/F, 5 days a week for 6 weeks to pelvis externally and followed by 3000-3500 rads intracavitarily. Sometimes 4500-5500 rads were given to paraaortic nodes (PAN) area if necessary.
The results are as follows
1. There was no difference about frequency according to clinical stage and histology between study group and control group. But there was difference in terms of age, that was 48.9 years of mean age in case of chemoradiotherapy group and 57.2 years in control group.
2. The response rates in chemoradiotherapy group were 48.3%(14/29) of cure, 34.5% of no response, and clinical remission followed by recurrence in 17.2%. In case of control group, the response rates were 79% (34/43) of cure, 7.0% of no response, and 14% of remission followed by recurrence. There was significant difference of response rates
between chemoradiotherapy group and control group (p=0-0073)
3. There was no difference of response rates between chemoradiotherapy group and control group below 50 years of age. But in case above 50 years of age, the response rates in chemoradiotherapy group are 61.5% of cure and 38.5% of no response. In case of control group, the response rates are 82.9% of cure, 8.6% of each of no response and remission followed by recurrence. So there was significant difference of response rates between chemoradiotherapy group and control group (p=0.034).
4. After 2-3 cycles of neoadjuvant chemotherapy, the overall response rate was 62.1% with a complete remission(CR) rate of 13.8%. There were also stable disease (SD) in 34.5% and progressive disease in 3.4%. After the completion of subsequent radiotherapy, all 4 patients with CR after chemotherapy were cured of the disease, but I patients with progressive disease in spite of chemotherapy had remission of the disease followed by recurrence. In case of patients with partial remission and SD after chemotherapy, more than half patients did not respond to radiotherapy or had remission of the disease followed by recurrence. These results suggest that the response to chemotherapy did not have an effect on the result of radiotherapy.
5. All of patients with chemotherapy had nausea and vomiting. 89.7% of patients had alopecia, 72.4% leucopenia, and 75.9% neutropenia. And only 6.9% of patients had grade 4 neutropenia with no further complication. There were also diarrhea, anemia, abdominal pain, stomatitis, and liver function abnormalities.. But all patients tolerated chemotherapy very well.
´In conclusion, induction chemotherapy- for primary radiotherapy proves that no therapeutic advantage may be achieved by combining radiotherapy and chemotherapy in the treatment of uterinecervix cancer with advanced disease and early disease with large mass more than 4cm.
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