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J Korean Soc Ther Radiol. 1993 Dec;11(2):355-362. English. Original Article.
Yang KM , Ahn SD , Choi EK , Chang HS , Kim YT , Nam JH , Mok JE .
Department of Therapeutic Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Department of Gynecologic Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Abstract

Since May 1991, authors have conducted a pilot study to determine the feasibility and evaluate the effect of concurrent radiation therapy and chemotherapy with 5-FU and Cis-platinum for locally advanced cervical cancer (stage IIB-IVA). Radiation therapy consisted of external irradiation to whole pelvis (4140 cGy/23 fx) in 4.5 weeks followed by high dose rate intracavitary radiation therapy (HDR ICRT) to deliver a dose of 30 to 35 Gy to A point in 6 to 7 fractions. After the intracavitary radiation therapy, parametrial boost was delivered for B point dose of 60 Gy in Stage IIB and 65 Gy in stage IIB. 5-FU (1000 mg/ m2/24hr for 96 hour iv infusion) and Cis-platinum (20 mg/m2/day IV bolus for 3 days) were given during the second week of external RT and the second course chemotherapy administered at the first HOR ICRT with the same method as the first chemotherapy. Sixteen patients (10 stage IIB, 4 stage IIIB, 2 stage IVA) were registered to this protocol. Among these 16 patients, two refused treatment after 2 fractions of external irradiation, and one could not continue intracavitary irradiation because of treatment related genitourinary toxicity. So 14 patients were evaluated for toxicity and 13 patients were evaluated for response analysis. Five of 14 patients developed grade 3 gastrointestinal toxicity but 4 of them recovered at the completion of treatment. One stage IIIB patient with inguinal lymph node metastasis who received higher dose of radiation in spite of initial poor performance status did not recover from gastrointestinal toxicity at the completion of treatment. And she died of distant metastasis at one month after the completion of treatment. Two of 14 evaluable patients showed weight loss, more than 10% of initial weight. One patient developed grade 3 leukcpenia. In this study, the average total treatment period of completely treated patients was 75 days and three of them took more than 80 days (84, 84, 89 days). Toxicities were generally acceptable and there were no treatment related death. At the last follow-up, complete response was achieved in 62% (8/13) and especially of nine patients with stage IIB, eight patients showed complete response. This study suggests that concurrent radiation therapy and chemotherapy (5-FU and Cis-platinum) is tolerable and effective. Further follow-up is needed to determine whether this protocol will have a favorable impact on survival and to evaluate the late effect on normal tissues. In future, prospective randomized trials are needed to compare the standard radiation therapy alone with concurrent chemotherapy and radiation therapy for locally advanced cervical carcinoma.

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