Comparison of Concurrent Chemoradiotherapy Regimen Toxicities in the Treatment of Loco-Regionally Advanced Cervical Cancer

Chang, Hye Jin; Ryu, Hee Sug; Chun, Mi Sun; Chang, Ki Hong; Lee, Jung Pil

Abstract

OBJECTIVE
Concurrent chemoradiotherapy is the idea where the chemotherapeutic agent acts as a radiosensitizer thus producing a synergistic effect between radiotherapy and chemotherapy. We evaluated the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) in loco-regionally advanced cervical cancer patients.
METHODS
The medical records were retrospectively reviewed for 24 patients who underwent CCRT (cisplatin 70 mg/m2 on day 1, 29; 5-FU: 1000 mg/m2 on day 2-5 and 30-33 X 4 cycles), 26 patients who underwent weekly CCRT (cisplatin: 40 mg/m2 X 6 weeks) and 62 patients who had underwent radiation therapy alone for loco-regionally advanced cervical cancer at Ajou University Hospital. Toxicity was assessed according to the Gynecologic Oncology Group toxicity criteria. Statistical analysis was performed with chi- squre test.
RESULTS
2 year overall survival rate of patients only treated with RT was 75.0% (39/52). When this was compaired to CCRT, 83.3% (20/24) with monthly CCRT and 88.5% (23/26) with weekly CCRT of 2 year overall survival rates were attained. Recurrence rates were measured 2 years after each therapy done, they were 30.8% (16/52) with RT, 25.0% (6/24) with weekly CCRT, and 23.1% (6/26) monthly CCRT. During CCRT, grade 3 and 4 acute complication rates of nausea/vomiting (20.8% vs. 3.8%) and leukocytopenia (29.1% vs. 15.4%) was significantly higher in monthly group compared to weekly group (p<0.05). Weekly group had more patients who completed planned therapy compaired to monthly group (70.9% vs. 84.6%).
CONCLUSION
CCRT improved overall survival rates and disease-free survival rate, but in some cases increased acute toxicity, and it is suggested that CCRT may be advantageous compared to radiation therapy for loco-regionally advanced cervical cancer. Weekly CCRT does not seem to afford distinct advantages in terms of acute toxicities over monthly CCRT, except for possible better patient compliance. Due to small size sample and short duration of follow up, further study of a large group of patients and the long survival rate is necessary.