Does adjunctive oxytocin infusion during balloon cervical ripening improve labor induction?

Evidence-Based Answer: Yes. Compared to the use of a transcervical balloon alone, combined cervical ripening with a balloon catheter and oxytocin shortens the time to overall delivery by 3 hours and the time to vaginal delivery by 4 hours, without altering the rate of cesarean section (strength of recommendation [SOR]: A, network meta-analysis). The effect is more pronounced in nulliparous patients (SOR: A, meta-analysis).When combined therapy is used, 6 hours of balloon time may result in faster delivery than 12 hours (SOR: B, single randomized controlled trial [RCT]). Fixed-dose oxytocin and titrated oxytocin appear to have similar effect when combined with a cervical ripening balloon (SOR: C, underpowered RCT).

Evaluation of concurrent and adjuvant carboplatin with radiation therapy for locally advanced cervical cancer.

OBJECTIVE: To analyze the toxicity profile and long-term outcomes of patients receiving carboplatin with concurrent radiation for locally advanced cervical cancer. METHODS: A retrospective study was performed to identify patients treated with carboplatin and concurrent radiation therapy for locally advanced cervical cancer with a minimum follow-up period of 24 months. Records were reviewed for demographic data, chemotherapy doses, toxicities, and survival outcomes. Specifically reviewed were hematologic, gastrointestinal, and renal toxicities and the need for dose modification and treatment delays. RESULTS: Twenty-one patients with cervical carcinoma Stage IIB (7), III (13), or IVA (1) treated with carboplatin chemotherapy from 1993 to 2001 were identified. Carboplatin at a dose of 300 mg/m(2) administered every 3 weeks for an intended six courses was initiated at the start of radiation therapy. No grade 3 or 4 thrombocytopenia or renal toxicity was observed. Nine patients had delays in chemotherapy administration and/or received a 25% reduction in the dose of chemotherapy based on one or more of the following: thrombocytopenia (platelet count <100000 cells/mcl) (n = 3), granulocytopenia (ANC <1.0) (n = 4), or anemia (hemoglobin <10.0 g/dl) (n = 5). The median carboplatin AUC was 3.9 (range 3.0-5.0). Six patients developed recurrent disease (five local and one distant) with a pelvic control rate of 76% and an overall survival of 71%. CONCLUSION: Carboplatin at a dose of 300 mg/m(2) (equivalent to an AUC of 3.9) on an every 3-week schedule is tolerable with concurrent pelvic radiation therapy for locally advanced cervical cancer. The efficacy of carboplatin, compared to cisplatin, as a radiation sensitizer can only be determined in a randomized clinical trial.