Introduction/Background To determine survival, acute toxicity (vascular and renal) and chronic renal impairment in high risk cervical cancer patients when treated with platinum-based induction chemotherapy followed by concurrent radiotherapy and hyperthermia.
Methodology Patients with large primary tumours (>6 cm), or para-aortic lymph node (LN) metastases >1 cm, or para-iliac LN >2 cm were treated with weekly platinum-based induction chemotherapy followed by concurrent radiotherapy with hyperthermia. Patient and tumour characteristics, Common Toxicity Criteria (CTC) scores, laboratory tests, and treatment data were retrieved from clinical charts.
Results From the hyperthermia database 105 patients were included with a median follow-up time of 43 months (95% CI 32-54). Mean age was 47.9 years (range 22–79) and median tumour size 6.0 cm (range 2.6–11.5). Clinical FIGO stage of > *IIIB was present in 30% and para-aortic LN were present in 47%. Eighty-six patients were scheduled with cisplatin therapy and 20 patients with carboplatin. At baseline a thrombo-embolic event (TEE) was present in 10 and 23 (22%) patients experienced a TEE (18% venous, 4% arterial) during chemotherapy. Because of renal toxicity during chemotherapy in 32 patients (37%), 10 patients stopped with cisplatin and 22 patients switched to carboplatin. At last available follow-up 30 patients (35%) with cisplatin therapy developed a CTCAE grade ≥2 chronic renal toxicity (GFR <59 mL/min). Five-year overall survival was 58%. There was no significant difference between women receiving cisplatin versus carboplatin.
Conclusion Although platinum-based induction chemotherapy followed by concurrent radiotherapy with hyperthermia is effective as treatment of advanced cervical cancer, there is a high risk of chemotherapy-associated TEE, acute and chronic renal toxicity due to cisplatin. To reduce toxicity, the treatment protocol has been changed to carboplatin based chemotherapy and in an observational study the use of prophylactic LMWH will be implemented.
Disclosure Nothing to disclose.
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