PURPOSE: To assess the efficacy of alternating chemoradiotherapy combined with extended-field conformal
radiotherapy for patients with high-risk
cervical cancer. METHODS AND MATERIALS: Patients with previously untreated
cervical cancer, with Stage III/IVA disease, or Stage IB/II with high-risk factor (
primary tumor diameter >/=50 mm or positive
lymph node) were entered into this study. Three cycles of
chemotherapy with 3,500 mg/m(2) of
5-fluorouracil (
5-FU) and
nedaplatin (NDP) were accompanied with
pelvic irradiation of 45.6-51.3 Gy in 24-27 fractions over 6 weeks. Prophylactic (36 Gy/20 fractions) or definitive (45-56 Gy)
irradiation for para-aortic region was followed by
pelvic irradiation. RESULTS: Between 1998 and 2004, 40 patients were recruited for this protocol study. Eighteen patients from Phase I setting were registered. Twenty-two patients were treated with NDP of 140 mg/m(2) (the recommended dose) in the Phase II segment. Twenty-five patients had T3 disease, and 25 patients had nodal disease including para-aortic involvement (n = 5). Overall/progression-free survival rates at 5 years were 78.8 and 66.5%, respectively. The
median follow-up time was 61.8 months (25.5-106.7).
Hematologic and
gastrointestinal Grade 3 or more toxicities were relatively high rate (27.5-45%); however, they were well manageable. Two for
bladder toxicity of Grade 3 were noted. Comparing the data from historical control group evaluated by
magnetic resonance imaging, alternating chemoradiotherapy revealed a significant favorable factor for survival and disease recurrence in
multivariate analysis (p < 0.05). CONCLUSION:
Acquired results from our unique protocol for
cervical cancer with high-risk factor were thought to be promising, considering that the majority of our cohort consisted of high-risk population.
