Intra-Arterial Infusion Chemotherapy Using Cisplatin With Radiotherapy for Stage III Squamous Cell Carcinoma of the Cervix

Kaneyasu, Yuko; Nagai, Nobutaka; Nagata, Yasushi; Hashimoto, Yasutoshi; Yuki, Shintaro; Murakami, Yuji; Kenjo, Masahiro; Kakizawa, Hideaki; Toyota, Naoyuki; Fujiwara, Hisaya; Kudo, Yoshiki; Ito, Katsuhide

doi:10.1016/j.ijrobp.2009.02.081

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Volume 75, Issue 2 , Pages 369-377, 1 October 2009

Intra-Arterial Infusion Chemotherapy Using Cisplatin With Radiotherapy for Stage III Squamous Cell Carcinoma of the Cervix

Yuko Kaneyasu, M.D., Ph.D.
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- Reprint requests to: Yuko Kaneyasu, M.D., Ph.D., Department of Radiation Oncology, Graduate School of Biomedical School Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima 734-8551, Japan. Tel: (+81) 82-257-5257; Fax: (+81) 82-257-5259
Nobutaka Nagai, M.D., Ph.D.
- Department of Obstetrics and Gynecology, Asa Citizen Hospital, Hiroshima, Japan
Yasushi Nagata, M.D., Ph.D.
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Yasutoshi Hashimoto, M.D.
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Shintaro Yuki, M.D.
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Yuji Murakami, M.D., Ph.D.
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Masahiro Kenjo, M.D.
- Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Hideaki Kakizawa, M.D., Ph.D.
- Graduate School of Biomedical Sciences, Department of Radiology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
Naoyuki Toyota, M.D., Ph.D.
- Graduate School of Biomedical Sciences, Department of Radiology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
Hisaya Fujiwara, M.D., Ph.D.
- Department of Obstetrics and Gynecology, Hiroshima University, Hiroshima, Japan
Yoshiki Kudo, M.D., Ph.D.
- Department of Obstetrics and Gynecology, Hiroshima University, Hiroshima, Japan
Katsuhide Ito, M.D., Ph.D.
- Graduate School of Biomedical Sciences, Department of Radiology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

Received 3 December 2008; received in revised form 12 February 2009; accepted 12 February 2009.

Purpose

To examine the effectiveness of concomitant intra-arterial infusion chemotherapy (IAIC) using cisplatin (CDDP) with radiotherapy for Stage III squamous cell carcinoma of the cervix.

Materials and Methods

We analyzed 29 cases of Stage III squamous cell carcinoma of the uterine cervix treated with radiotherapy and IAIC of CDDP from 1991 to 2006. External-beam therapy was given to the whole pelvis using four opposing parallel fields with an 18-MV linear accelerator unit. A central shield was used after 30–40 Gy with external whole-pelvic irradiation, and the total dose was 50 Gy. High-dose-rate brachytherapy was given with ¹⁹²Ir microSelectron. The dose at Point A was 6 Gy per fraction, 2 fractions per week, and the total number of fractions was either 3 or 4. Two or three courses of IAIC were given concomitantly with CDDP 120 mg or carboplatin 300 mg.

Results

We confirmed excellent medicine distribution directly by using computed tomographic angiography. The 5-year overall survival rate for Stage III patients was 62%, the cause-specific survival rate was 70%, and the local relapse-free survival rate was 89%. Local recurrence, distant metastasis, and occurrences of both were 7%, 38%, and 3%, respectively. The incidence of severe acute hematologic adverse reactions (Grade ≥3) was 27% for all patients; however, all recovered without interruption of radiotherapy. Severe nonhematologic effects (Grade ≥3) were 3%, including nausea and ileus. Only 1 patient's radiotherapy was interrupted for a period of 1 week because of ileus. Severe late complication rates (Grade ≥3) for the bladder, rectum, and intestine were 3%, 3%, and 10%, respectively.

Conclusion

A combination of IAIC and systemic chemotherapy should be considered to improve the prognosis of patients with Stage III squamous cell carcinoma of the cervix.

Cervical carcinoma, Intra-arterial infusion chemotherapy, Radiotherapy, High-dose-rate brachytherapy