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A Phase II Trial of Less Than 7 Weeks of Concomitant Cisplatin-Paclitaxel Chemoradiation in Locally Advanced Cervical Cancer
  1. Rafael MartÍNez-Monge, MD*,
  2. Miren GaztaÑAga, MD*,
  3. José Manuel AramendÍA, MD*,
  4. Mauricio Cambeiro, MD*,
  5. Leire Arbea, MD*,
  6. Jaime EspinÓS, MD*,
  7. José Javier Aristu, MD* and
  8. Matías Jurado, MD
  1. *Departments of Oncology, and
  2. Gynecology and Obstaetrics, Clínica Universidad de Navarra, University of Navarra, Pamplona, Navarre, Spain.
  1. Address correspondence and reprint requests to Miren Gaztañaga, MD, Department of Oncology, Clínica Universitaria de Navarra, University of Navarre, Avda Pío XII s/n, Pamplona, Navarre, Spain. E-mail: mgaztana{at}unav.es.

Abstract

Objectives: This study was undertaken to determine the tolerability of a 7-week schedule of external beam radiation therapy, high-dose-rate brachytherapy, and weekly cisplatin and paclitaxel in patients with locally advanced carcinoma of the cervix.

Methods: Twenty-nine patients with International Federation of Gynecology and Obstetrics stages IB2 to IVa cervical cancer were treated with 40 mg/m2 per week of intravenous (i.v.) cisplatin and 50 mg/m2 per week of i.v. paclitaxel combined with 45 Gy of pelvic external beam radiation therapy and 30 Gy of high-dose-rate brachytherapy.

Results: Eleven patients (37.9%) were able to complete the 6 scheduled cycles of chemotherapy. The median number of weekly chemotherapy cycles administered was 5 (range, 2-7). Thirty-five (20.1%) of 174 cycles of chemotherapy were not given because of toxicity. The median dose intensity of cisplatin was 31 mg/m2 per week (95% confidence interval [CI], 25.2-36.8); that of paclitaxel was 44 mg/m2 per week (95% CI, 39.9-48.3). Twenty-two patients (78.6%) were able to complete the planned radiation course in less than 7 weeks. Median radiation treatment length was 45 days (95% CI, 43.4-46.6). After a median follow-up of 48 months, 7 patients (24.1%) experienced severe (Radiation Therapy Oncology Group grade 3 or higher) late toxicity. No fatal events were observed. Seven patients have failed, 1 locally and 6 at distant sites. The 8-year local/pelvic control rate was 95.7%, and the 8-year freedom from systemic failure rate was 76.1%. Eight-year actuarial disease-free survival and overall survival were 63.1% and 75.9%, respectively.

Conclusions: This study demonstrated unacceptable toxicity of combining the stated doses of concurrent cisplatin and paclitaxel chemotherapy with definitive radiotherapy for patients with advanced cervical cancer. Additional phase I/II trials are recommended to clearly establish the recommended phase II dose for these drugs.

  • Cervical cancer
  • Chemoradiation
  • Cisplatin
  • Paclitaxel
  • Toxicity

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Footnotes

  • Drs Rafael Martínez-Monge and Miren Gaztañaga equally contributed to this article.

  • The authors declare no conflicts of interest. No funding was received for this work.

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