ABSTRACT
Background: Carcinoma of cervix is the most common malignancy of women at our center and the majority of cases present locally advanced stages. The aim of this study was to assess the efficacy and toxicity of carboplatin based concurrent chemoradiation in patients with locally advanced cervical carcinoma. Methods: Fifty seven locally advanced cervical cancer patients were enrolled in this study and fifty eligible patients were received weekly carboplatin at dose of area under curve 2, along with radical radiotherapy. The total dose of 50 Gy in 25 fractions over a period of 5 weeks was given during external beam radiotherapy and 19.5 Gy (6.5 Gy per fraction/week) was given during high dose rate achytherapy. Results: After two months of completion of treatment the complete response rate was observed in 37(74%) patients, with 11 (22%) patients had partial response and 02 (04%) patients had stable disease or no response to treatment. The hematological toxicities with grade III were observed in 06(12%) patients and grade IV observed in 02(04%) patients. Conclusion: Despite initial promising results with acceptable toxicities, further large randomized study is needed to judge the efficacy of carboplatin along with radical radiotherapy in cervical cancer patients.
ABSTRACT
OBJECTIVE: The use of non-platinum drugs in concurrent chemoradiation in carcinoma cervix has not been well explored and hence a two arm study was planned to compare the outcome of concomitant cisplatin or gemcitabine in locally advanced carcinoma cervix. METHODS: Thirty six patients were evaluated in this study for response rates and complications. These patients were divided into two arms, sixteen patients in the cisplatin arm and twenty patients in the gemcitabine arm. Cisplatin and gemcitabine were given as i.v. infusion at doses of 40 mg/m2 and 150 mg/m2 respectively for five weeks concomitant with radiotherapy. All patients had received pelvic radiotherapy to a dose of 50 Gy/25 fraction/5 weeks by four field box technique followed by high-dose-rate brachytherapy (3 sessions, each of 7.5 Gy to point A). RESULTS: Median follow up was of 10.4 months (range, 3 to 36 months) and 10.9 months (range, 2 to 49 months) in the cisplatin and gemcitabine arms, respectively. At first follow up, 68.8% in the cisplatin arm and 70% in the gemcitabine arm had achieved complete response (p=0.93). Similar response rates were noted in different stages in both arms. None of the patients except one developed grade 4 toxicity. Similar toxicity profiles were observed in both arms. Local disease control, distant disease free survival and overall survival was 68.8% vs. 70%, 93.8% vs. 85%, 68.8% vs. 60% in the cisplatin and gemcitabine arms, respectively. CONCLUSION: Weekly gemcitabine had similar disease control and tolerable toxicity profile with cisplatin. Gemcitabine may be used as an alternative to cisplatin in patients with compromised renal function.