Role of chemoradiotherapy in advanced carcinoma cervix

Carcinoma cervix is the commonest female malignancy in India. In advanced stages radiotherapy was the only treatment options available. Recently there is interest in chemotherapy but the combination, dosage and timing are not well standardised. With this background a trial was undertaken to evaluate the role of chemotherapy along with radiotherapy in advanced carcinoma cervix. One hundred and sixty patients of stages II B-IV A carcinoma cervix were randomised into two arms. Patients of radiotherapy alone arm were treated by external radiotherapy of 5000 cGy in conventional fractionation followed by brachytherapy. The second group received the same schedule of radiotherapy plus chemotherapy with injection cisplatin 30 mg/m2 once weekly for 5 weeks during the course of external radiotherapy. Patients were well matched in both the arms. Compliance rate is similar. The complete response rate was 83% with chemoradiotherapy arm while it was 73% with radiotherapy (p-value > 0.1). Neutropenia was the major dose limiting toxicity, the incidence and severity being more in chemoradiotherapy arm (grade 3 neutropenia 12% versus 0%). Radiation proctitis was the commonest late effect observed. In the median follow-up of 54 months, there is an increased overall survival (56% versus 47%); p-value > 0.1) and disease-free survival (51% versus 37%; p-value > 0.05) in the chemoradiotherapy arm.