Can Chemotherapy be Integrated with Brachytherapy in Locally Advanced Carcinoma Cervix- A Proof of Principle Study

Introduction: Cancer of the cervix is the second most common cancer in women in India. Chemoradiotherapy is the standard treatment for locally advanced carcinoma cervix. Chemotherapy is not given on days of brachytherapy due to the fear of increased toxicity though studies supporting or refuting it are limited. We intended to study feasibility of adding chemotherapy to brachytherapy with assessment of acute toxicity and response rates. Methods: 29 patients of locally advanced carcinoma cervix (FIGO IIB to IIIB) were assigned to receive either three sessions of high dose rate (HDR) brachytherapy alone or HDR brachytherapy with concurrent chemotherapy of Paclitaxel and Carboplatin after completion of external beam radiation with concurrent Cisplatin. Patients were assessed for compliance of treatment, toxicity and response rates at three and six months. The p-value less than 0.05 was considered statistically significant. Fischer’s exact test was used for statistical analysis. Results: 15 patients were assigned to the standard of care arm and 14 patients to the experimental chemo-brachytherapy arm. The median number of cycles of chemotherapy possible with brachytherapy was two (Range: 1 -3). At three months after treatment all patients except one patient in each arm had a complete response. There was two acute grade 3 hematological toxicity and two acute grade 3 or higher gastrointestinal toxicity in the experimental arm but none in the standard arm. The experimental arm had a statistically higher incidence of acute grade 3 and 4 toxicity than the standard arm (p=0.042). Conclusions: Chemo-brachytherapy is associated with higher acute toxicity with comparable response rates. Small patient numbers and short follow up impedes us from providing conclusive evidence.