Local implant of sustained-release 5-fluorouracil and cisplatin combined with radiotherapy in the treatment of cervical cancers / 中华放射肿瘤学杂志

ABSTRACT

Objective To study if local implant of sustained-release 5-fluorouracil (5-Fu) and cisplatin (DDP) combined with radiotherapy can improve the treatment result of advanced and recurrent cervical cancer. Methods Forty-two patients with advanced (26 with stage Ⅲ) or recurrent (16) cervical cancer received local implant of sustained-release 5-Fu and DDP combined with radiotherapy ( group A), and 40 ( including 29 with stage Ⅲ and Ⅱ with recurrent cervical cancer) received radiotherapy alone during the same period as the control (group B). In group A, the pelvic external radiation was 45-55 Gy (including 25-30 Gy to the whole pelvis) over 6-7 weeks using 6-10 MV X-beams; 192Ir intracavity brachytherapy was 24-36 Gy in 4-6 fractions to the point "A", while the patients with Ⅲ A disease received 24-32 Gy in 3-4 fractions to 0.5 cm depth from the surface of vaginal mucosa; Sustained-release 5-Fu (200-400 rag) and DDP (40-80 mg) were implanted by puncture before and during the course of radiotherapy. In group B, the external beam radiation was as same as in group A, except that there was 8-12 Gy boosting to the local tumor in group B; The brachytherapy was 30-42 Gy to point "A", and those with ⅢA disease received 40-48 Gy to 0.5 cm depth from the surface of vaginal mucosa. Treatment efficacy and complications were compared be tween the two groups. Results In group A and B, the complete response rate (CR) was 69% and 30% (X2=12.50,P<0.01 ), respectively. The 3-year tumor-free survival rate was 62% and 25 % (X2=11.33,P<0.01), respectively. The time between the treatment and tumor response was shorter in group A then in group B. The toxicities of the bone marrow, the rectum and the bladder were similar between the two groups. Conclusions Local implant of sustained-release 5-Fu and DDP combined with radiotherapy could improve the results of patients with advanced or recurrent cervical cancer, without increasing the treatment toxicities.