Concurrent weekly cisplatin plus external beam radiotherapy and high-dose rate brachytherapy for advanced cervical cancer: A control cohort comparison with radiation alone on treatment outcome and complications

Chen, Shang-Wen; Liang, Ji-An; Hung, Yao-Ching; Yeh, Lian-Shung; Chang, Wei-Chun; Lin, Wu-Chou; Yang, Shih-Neng; Lin, Fang-Jen

doi:10.1016/j.ijrobp.2006.07.004

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 66, Issue 5 , Pages 1370-1377, 1 December 2006

Concurrent weekly cisplatin plus external beam radiotherapy and high-dose rate brachytherapy for advanced cervical cancer: A control cohort comparison with radiation alone on treatment outcome and complications

Shang-Wen Chen, M.D.
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Reprint requests to: Shang-Wen Chen, M.D., Department of Radiation Therapy and Oncology, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan 404. Tel: (+886) 4-2205-2121, ext. 2411; Fax: (+886) 4-2205-2121, ext. 2499.
Ji-An Liang, M.D.
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
Yao-Ching Hung, M.D.
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
Lian-Shung Yeh, M.D.
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
Wei-Chun Chang, M.D.
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
Wu-Chou Lin, M.D.
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
Shih-Neng Yang, M.D.
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
Fang-Jen Lin, M.D., Ph.D.
- Department of Radiation Therapy and Oncology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan

Received 27 May 2006; received in revised form 5 July 2006; accepted 5 July 2006. published online 15 September 2006.

Purpose: To test, though a control-cohort study, the hypothesis that concurrent chemoradiotherapy (CCRT) using weekly cisplatin, plus high-dose rate intracavitary brachytherapy (HDRICB) is superior to radiation (RT) alone in patients with advanced cervical cancer.

Methods and Materials: A total of 171 patients with Stage IIB–III cervical cancer were enrolled in this study. Seventy patients were treated with CCRT and the results were compared with those of 101 patients who had been treated with RT using the same protocol at an early period. RT consisted of 45 Gy in 25 fractions to the whole pelvis, followed by a 12.6-Gy boost to the parametrium. Four courses of HDRICB using 6.0 Gy to Point A were performed. Chemotherapy consisted of weekly cisplatin at a dose of 40 mg/m² for 5–6 cycles.

Results: The 4-year actuarial survival was 74% for the CCRT group and 68% for the RT group (p = 0.60). The 4-year pelvic relapse-free survival was 87% for the CCRT group and 85% for the RT group (p = 0.37). The 4-year distant metastases-free survival was 75% for the CCRT group and 76% for the RT group (p = 0.44). The cumulative incidence of gastrointestinal and genitourinary injuries of grade 3 or above was 14.3% for the CCRT group and 7.9% for the RT group (p = 0.19).

Conclusion: This study did not show a survival benefit of CCRT with weekly cisplatin and HDRICB for Stage II–III cervical cancer, nor did it demonstrate a significant increase of late complications when comparing with RT alone.

Keywords: Carcinoma of the cervix, Radiotherapy, Concurrent chemoradiotherapy, High-dose rate brachytherapy, Complications