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Concurrent chemoradiation in advanced cervical cancer.
1Department of Radiation Oncology, Toronto Bayview Regional Cancer Centre, Ontario, Canada.
Gynecologic Oncology
|September 1, 1990
Summary
Concurrent chemoradiation with fluorouracil (5-FU) shows promise for locally advanced cervical cancer, reducing pelvic failure and toxicity. Further phase III studies are warranted to confirm improved outcomes.
Area of Science:
- Gynecology
- Oncology
- Radiotherapy
Background:
- Pelvic failure is common in locally advanced cervical cancer treated with radical radiotherapy (RT).
- Concurrent chemoradiation aims to improve treatment efficacy and reduce recurrence rates.
Purpose of the Study:
- To report results of phase I-II studies evaluating concurrent chemoradiation in patients with bulky cervical cancer.
- To establish an acceptable and effective treatment regimen for locally advanced cervical cancer.
Main Methods:
- 200 patients with bulky cervical cancer received sequential protocols of concurrent chemoradiation between 1981-1988.
- Radiotherapy included pelvic or pelvic plus paraaortic fields with continuous or split-course regimens.
- Infusional fluorouracil (5-FU) was administered concurrently with RT, with or without mitomycin C (Mit-C).
Main Results:
- Three-year pelvic control and survival rates were 85% and 71% for stage Ib/II, and 50% and 42% for stage III/IV, respectively.
- Concurrent RT with 5-FU alone showed fewer complications than historical standard pelvic RT.
- Mitomycin C (Mit-C) use was significantly associated with increased late complications (P = 0.0053).
Conclusions:
- Concurrent chemoradiation with 5-FU demonstrates encouraging results in locally advanced cervical cancer, with reduced toxicity compared to RT alone.
- The addition of 5-FU to continuous partially hyperfractionated pelvic RT is being investigated in a phase III study for improved local control and survival.