Concurrent 5-fluorouracil, mitomycin C and irradiation in locally advanced cervix cancer

We reviewed 177 patients treated with radical radiotherapy for locally advanced (FIGO stages IIB, IIIA, IIIB) cervix cancer between January 1979 and December 1989. The radiotherapy was given by external beam treatment to the pelvis and by an intracavitary caesium insertion. Ninety-three patients also received chemotherapy which consisted of infusional 5-fluorouracil during the first and last weeks of the external beam component of the radiotherapy, combined with bolus mitomycin C (group A, 64 patients) or without mitomycin C (group B, 29 patients). These groups were compared with patients treated by radiotherapy alone (group C, 84 patients). The median follow-up was 7.2 years. The median survival time for all patients was 47 months, but was significantly higher (87 months, p = 0.004) for group A. Rates of relapse-free survival and local control were also higher in group A. Toxicity was assessed in detail using the Franco-Italian glossary. There was a relatively high rate of complications, particularly in group A, with 36% of patients having grade 3 or 4 complications. This increase in toxicity persisted through all follow-up time intervals. Patients in group B also demonstrated a higher rate of toxicity than group C, but this increase was limited to the first 6 months of follow-up. The use of mitomycin C in addition to radiotherapy and 5-fluorouracil should be regarded with caution, as other studies have also shown that toxicity is increased, but without improvements in survival.