Article Text

Download PDFPDF
Clinical Outcome of Neoadjuvant Radiochemotherapy in Locally Advanced Cervical Cancer: Results of an Open Prospective, Multicenter Phase 2 Study of the North-Eastern German Society of Gynecological Oncology
  1. Dominique Koensgen*,
  2. Jalid Sehouli,
  3. Antje Belau*,
  4. Martin Weiss,
  5. Matthias B. Stope,
  6. Vivien Großkopf*,
  7. Michael Eichbaum§,
  8. Peter Ledwon,
  9. Werner Lichtenegger,
  10. Marek Zygmunt*,
  11. Günter Köhler* and
  12. Alexander Mustea, MD*
  1. *Department of Gynecology and Obstetrics, University Medicine Greifswald, Greifswald;
  2. Department of Gynecology and Gynecological Oncology, Charité Berlin, Berlin;
  3. Department of Urology, University Medicine Greifswald, Greifswald;
  4. §Department of Obstetrics and Gynecology, University Hospital Heidelberg; and
  5. Department of Obstetrics and Gynecology, Städtisches Klinikum Brandenburg, Germany.
  1. Address correspondence and reprint requests to Alexander Mustea, Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany. E-mail: mustea@uni-greifswald.de.

Abstract

Objective The aim of this study was to determine the response rate, toxicity, operability, and surgical complication rate of neoadjuvant concomitant radiochemotherapy (cRCH) (ifosfamide + carboplatin) followed by radical hysterectomy plus external-beam radiotherapy with curative intention in locally advanced primary inoperable stages IIB and IIIB squamous cell cervical cancer.

Methods Patients with cervical cancer from 8 departments were enrolled. Patients received 3 cycles of ifosfamide 1.2 mg/m2 (+mesna 20%) plus carboplatin (area under the curve = 4), every 21 days, and concomitant external-beam radiotherapy (50.4 Gy [1.8 Gy/d]). Operability and remission were evaluated by clinical gynecological examination in general anesthesia (magnetic resonance imaging was optional), 4 weeks after the third cycle of cRCH. In case of achieved operability, a radical hysterectomy with pelvic lymphadenectomy was performed within 6 weeks after cRCH. If surgery was not performed because of incomplete remission or patient preferences, vaginal brachytherapy (15 Gy [5 Gy/d]) was given additionally.

Results Forty-four patients were enrolled. Distribution of FIGO (International Federation of Gynecology and Obstetrics) tumor stage was as follows: IIB (19 patients) and IIIB (25 patients). All patients completed cRCH. Grade 3/4 hematologic toxicities (% of all cycles) were moderate: leukopenia, 7.3; thrombocytopenia, 2.4; and anemia, 3.2. In 13.8%, treatment cycles were delayed because of hematologic toxicity. Blood transfusions were given in 17.7% and granulocyte colony-stimulating factor in 39.5%. Overall, grade 3/4 nonhematologic toxicities were seldom (6.5%). Clinical overall response rate was 95.2%. Operability was achieved in 85.7%. Surgery was performed in 83.3%. Pathological response rates were as follows: pathological complete remission, 33.3%; partial remission, 63.3%; stable disease, 3.3%.

Conclusions Our study demonstrates that cRCH is an effective and tolerable regimen in locally advanced cervical cancer treatment.

  • Cervical cancer
  • Neoadjuvant treatment
  • Radiochemotherapy

Statistics from Altmetric.com

Footnotes

  • This work was supported on behalf of the the North-Eastern German Society of Gynecologic Oncology. on behalf of the North-Eastern German Society of Gynecologic Oncology

  • The authors declare no conflicts of interest.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.