Concurrent Chemo- Radiobrachytherapy with Cisplatin and Medium Dose Rate Intra- Cavitary Brachytherapy for Locally Advanced Uterine Cervical Cancer

Document Type: Research Articles

Authors

1 Radiation Oncology Research Center, Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

2 Department of Radiation Oncology, Zanjan University of Medical Sciences, Zanjan, Iran.

Abstract

Objective: Cervical carcinoma is the third most common gynecologic cancer, after ovarian and uterine cancers
in Iran. The aim of this study was to evaluate the efficacy (response rate) and toxicity of adding Medium Dose Rate
(MDR) brachytherapy with concurrent chemotherapy to External Beam Radiotherapy (EBRT) for the treatment of
locally advanced uterine cervical carcinoma. Methods: This phase I-II study was conducted in 2007-2008 at the cancer
institute, Tehran University of Medical Sciences. Patients were treated with pelvic EBRT (50 Gy in 25 Fraction) with
concomitant chemotherapy to obtain tumor shrinkage and permit optimal intra-cavitary placement. One week after the
completion of EBRT, patients were treated by 12 Gy MDR Intra-cavitary brachytherapy for two periods of one day
with a one week interval and concomitant platinum based chemotherapy. Response rate was evaluated by gynecologic
physical examination and pelvic MRI +- GD within three months of treatment. Acute and late toxicity were assessed
using Radiation Therapy Oncology Group criteria. Results: A total of 33 patients with locally advanced cervical cancer
were treated according to the above described treatment protocol. The patients mean age was 53.2 (range 31–78) years.
Three months after the completion of treatment, the complete clinical, pathologic and radiologic response rate according
to WHO-criteria was 81.8% (27 patients). Six cases had a partial response or stable disease. After 48 months, average
disease free survival periods were 45.1, 23.0, 33.4 and 8 months for stage IIB, IIIA, IIIB and: IVA lesions (according to
The International Federation of Gynecology and Obstetrics staging system). The most frequently observed side effects
were leukopenia, anemia, proctitis, cystitis, nausea and vomiting (mostly grade 1 and 2). Conclusion: Concomitant
brachytherapy and chemotherapy with platinum compounds can be well tolerated and is effective in the treatment of
locally advanced cervical cancer.

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