Treatment results of incomplete chemoradiotherapy in locally advanced cervical cancer

Abstract

Objective: Regimens that combine chemotherapy and radiotherapy increase toxicity and compromise a patient's ability to adhere to the treatment plan. We evaluated the efficacy and safety of a partially completed chemoradiation regimen prescribed for locally advanced carcinoma of the cervix.

Methods: Medical records of 156 patients with locally advanced cervical cancer stage IIB-IVA who received chemoradiation with cisplatin (40 mg/m(2)) and 5-fluorouracil (500 mg/ m(2)) from October 2006 to October 2008 were collected. The treatment protocol called for two cycles of chemotherapy. External beam radiation therapy was administered using a 10-MeV electron beam. Local control, disease free survival, overall survival, and toxicities were evaluated.

Results: With a median follow-up of 37.5 months, 89 patients (57%) completed the planned protocol. Sixty seven patients (43%) completed fewer than two cycles. The 3-year local control rate was significantly better in the patient group that completed the prescribed plan (92.1% compared to 80.6%; P = 0.033). No statistical significance was observed between the groups that completed or did not complete the two cycle protocol with regard to disease free survival (80.9% and 73.2%, respectively; P = 0.250), overall survival (84.3% and 79.1%; P = 0.405), and progression survival (3.4% and 3.0%; P = 0.892). Differences in acute hematologic toxicity and subcutaneous toxicity were observed between the two groups.

Conclusions: Completion of two cycles of 5-fluorouracil and cisplatin with radiotherapy was effective, safe, and responsible for better local control; toxicity was acceptable. Disease free survival and overall survival were similar between the treatment groups.

Keywords: 5-fluorouracil; cervical cancer; chemoradiotherapy; cisplatin; local control; toxicity.

Figure 1

Survival analysis in locally advanced cervical carcinoma, stratified by groups I and II (P > 0.05, all). (A) Overall survival curves. (B) Disease free survival curves. (C) Overall survival curves of stage IIB patients. (D) Disease-free survival curves of stage IIB patients. (E) Overall survival curves of stage IIIB patients. (F) Disease free survival curves of stage IIIB patients.