Aggressive multimodality treatment for cervical cancer with paraaortic lymph node metastases

A Phase I/II trial of weekly cisplatin and extended field radiation therapy for cervical carcinoma and paraaortic metastases was initiated. A total of 13 patients have entered this trial since 1985. The objective of the study was to determine the efficacy and toxicity of extended field radiation therapy and cisplatin as a radiation sensitizer in this high-risk group of patients. The addition of paraaortic nodal radiation was derived from our earlier trial using cisplatin and pelvic radiation therapy followed by combination chemotherapy (cisplatin, adriamycin and cytoxan). Of the 13 patients entered, 8 are alive without evidence of disease and 5 have recurred, all exclusively outside the treatment fields. Three of the five had positive scalene node biopsies prior to the initiation of therapy. Four patients have died from distant metastases, one is alive with lung and bone metastases, and there have been no recurrences in the pelvis or paraaortic treated areas. The encouraging results of complete local and pelvic control of tumor and acceptable toxicity warrants continuation of this trial.