Concurrent chemoradiotherapy with paclitaxel and nedaplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix / 中国癌症杂志

ABSTRACT

Background and purpose:Cisplatin-based concurrent chemoradiotherapy(CCRT) has become the standard treatment for locally advanced cervical cancer(LACC) . But no marked survival benefi t was found for stage Ⅲ-ⅣA patients,and the high toxicity of cisplatin warrants evaluation of other chemotherapeutic agents to increase effi cacy and decrease toxicity. This study was done to evaluate the effi cacy and toxicity of paclitaxel(TXL) and nedaplatin(NDP) administered concurrently with radiotherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell cervical carcinoma(LASCC) . Methods:29 Patients with LASCC(FIGO stage ⅡB-ⅢB) were enrolled into this study from February 5,2007 through December 10,2007. The median age was 48 years old(35-64) . Radiotherapy included external beam radiotherapy to pelvic(stageⅡB 45Gy,stage Ⅲ 50 Gy) and 192Ir brachytherapy(stageⅡB 50 Gy,stage Ⅲ 35Gy) . TXL 35 mg/m2 and NDP 20 mg/m2 were given every week for 6 weeks concurrently with radiotherapy. After one month of CCRT,TXL 135 mg/m2 and NDP 60mg/m2 were administered every 3 weeks for 4 cycles. Results:All patients completed CCRT. For the consolidation chemotherapy,25 patients received 4 cycles,2 patients 3 cycles and 2 patients 2 cycles. The clinical complete response rate was 89.7%(95%CI,78.6%-100%) ,partial response rate 10.3%(95%CI,0-21.4%) After a median follow-up of 14 months(range,8.7-18.8 months) ,the disease-free and overall survival rates were 86.2%(95% CI,73.7%-98.7%) and 96.7%(95% CI 90.2%-100%) ,respectively. One patient died due to disease progression.During CCRT,Grade 3 leukopenia occurred in 3.6%(6/169) of the cycles,Grade 3 diarrhea 0.6%(1/169) ;During consolidation chemotherapy,Grade 3 leukopenia and neutropenia occurred in 8.7%(9/104) of the cycles. There were 2 patients who developed Grade 3 late rectum toxicity. Conclusion:CCRT with paclitaxel and nedaplatin followed by consolidation chemotherapy is well tolerated and effective in patients with LASCC. A prospective randomized trial to compare this treatment strategy with standard CCRT seems to be worthwhile.