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Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma (LASCC) of the cervix uteri

Purpose: To evaluate the efficacy and toxicity of concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in the treatment of LASCC. Ifosfamide 2000 mg/m2 (24 hr infusion) + cisplatin 75 mg/m2 (1 hr infusion) were exclusively applied during two low-dose-rate brachytherapy applications exploring the synergistic effect of ifosfamide with such type of irradiation, and four cycles of consolidation chemotherapy with ifosfamide 2000 mg/m2 (3 hr infusion) (days 1-3) + cisplatin 75 mg/m2 were given after completion of radiotherapy. Planned dose to point A was 85 Gy. Results: All 34 patients had biopsy proven LASCC of the cervix uteri. Median age of patients was 51.3 years and median performance status (ECOG) was 0 (range 0-1). FIGO stage was IB2 in 7 (20%), IIA in 5 (15%), IIB in 16 (47%), IIIB in 5 (15%), and IVA in 1 patient (3%). All patients achieved complete response to ordinated therapy, determined by cervical biopsies, CT scans and clinical examination. After a median follow-up of 16.1 months the recurrence-free survival was 97%. No severe toxicities were observed. Most prominent toxicities (mostly of grade 1 and 2) were leucopenia, thrombocytopenia, anemia, nausea and vomiting. Early delayed local adverse events were detected in only four cases (12%) (rectum and bladder). Conclusion: The results indicate that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin is a well-tolerated and extremely effective treatment for patients with LASCC of the cervix uteri. A confirmatory, prospective, randomized phase III trial has just started.

cervical cancer; concomitant chemoradiation; ifosfamide; cisplatin

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