BACKGROUND: Cisplatin-based chemoradiation (CRT) is the standard treatment for patients with locally advanced cervical cancer. Epidermal growth factor receptor (EGFR) is frequently overexpressed in cervical cancer, and EGFR inhibition itself has antitumor effects and potentiates CRT. Results of a previous phase 1 trial of the EGFR inhibitor erlotinib combined with cisplatin-based CRT (E 1 CRT) recommended a phase 2 erlotinib dose of 150 mg/day. METHODS: Eligibility criteria included International Federation of Gynecology and Obstetrics stage IIB to IIIB epidermoid cervical cancer, no prior therapy, and an Eastern Cooperative Oncology Group performance status of 0 to 2. Patients received erlotinib at a dose of 150 mg/day 1 week before and in combination with cisplatin (40 mg/m 2 administered weekly for 5 cycles) and radiotherapy (4500 centigrays in 25 fractions), followed by brachytherapy (4 fractions at a dose of 600 centigrays weekly). RESULTS: A total of 36 patients completed treatment with E 1 CRT. The median duration of therapy was 77 days and the median follow-up period was 59.3 months. The therapy was well tolerated overall, and 34 patients (94.4%) achieved a complete response. The 2-year and 3-year cumulative overall and progression-free survival rates were 91.7% and 80.6% and 80% and 73.8%, respectively. CONCLUSIONS: Treatment with E 1 CRT appears to be safe and exerts significant activity against locally advanced cervical cancer. To the best of the authors' knowledge, this is the first study to date to demonstrate that a target agent has promising activity against locally advanced cervical cancer. Cancer 2014;120:1187-93.

Artigo disponível em português e inglês em: www.scielo.br/rsp Survival of a cohort of women with cervical cancer diagnosed in a Brazilian cancer center Sobrevida de mulheres com câncer de colo uterino diagnosticadas em um centro brasileiro ABSTRACT OBJECTIVE: To assess overall survival of women with cervical cancer and describe prognostic factors associated. METHODS:A total of 3,341 cases of invasive cervical cancer diagnosed at the Brazilian Cancer Institute, Rio de Janeiro, southeastern Brazil, between 1999 and 2004 were selected. Clinical and pathological characteristics and follow-up data were collected. There were performed a survival analysis using Kaplan-Meier curves and a multivariate analysis through Cox model.

Purpose: This phase I trial was aimed to determine the maximum tolerated dose and related toxicity of erlotinib (E) when administered concurrently with standard chemoradiation (CRT) for cervical cancer. Experimental Design: In a modified Fibonacci design, the study aimed to study three cohorts of at least three patients receiving escalating doses of erlotinib (50/100/150 mg) combined with cisplatin (40 mg/m 2 , weekly, 5 cycles) and radiotherapy (external beam 4,500 cGy in 25 fractions, followed by 4 fractions/600 cGy/weekly of brachytherapy) in squamous cell cervical carcinoma patients, stage IIB to IIIB. Results: Fifteen patients were enrolled, 3 at dose level (DL) 50 mg, 4 at DL100 mg, and 8 at DL 150 mg. Patients presented median age 47 (36-59), stage IIB (46.2%) and IIIB (53.8%). Overall, E+CRT was well-tolerated. Three patients did not complete the planned schedule. One patient at DL 100 mg withdrew informed consent due to grade 2 rash; at DL 150 mg, 1 patient presented Raynaud's Syndrome and had C interrupted, and another patient presented grade 4 hepatotoxicity. The latter was interpreted as dose limiting toxicity and a new cohort of 150 mg was started. No further grade 4 toxicity occurred. Grade 3 toxicity occurred in 6 cases: diarrhea in 3 patients, rash in 2 patients, and leukopenia in 1 patient. E+CRT did not lead to limiting in-field toxicity. Conclusions: E+CRT is feasible to locally advanced squamous cell cervical cancer and is well tolerated.The maximum tolerated dose has been defined as150 mg.To the best of our knowledge, this is the first report of a combination of erlotinib, cisplatin, and pelvic radiotherapy.

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This retrospective study has demonstrated that paclitaxel-carboplatin is an active and well-tolerated regimen for the treatment of advanced cervical cancer.

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The objective of this article was to analyze the treatment modalities used at the Brazilian National Cancer Institute, with particular emphasis on the use of radiotherapy (RT) and its indications in invasive cervical cancer, considering the staging and clinical epidemiological characteristics of the population. All cases of primary invasive tumors of the cervix (CID C53) registered at the institute and diagnosed between 1999 and 2004 were selected. The following variables were studied: (1) age, (2) year of diagnosis, (3) level of schooling, (4) race, (5) histopathologic subtype, (6) the staging of the tumor on diagnosis, and (7) the treatment modality initially offered. We analyzed 3509 cases of invasive disease, and 79.7% of them received RT. Based on the final logistic model, it was possible to construct a probabilistic model for the indication of RT in the subgroups formed by the combinations of the 3 highlighted variables (stage, age, and histological type). The likelihood varied from 22.5% in those with epidermoid carcinoma, stage I, younger than 55 years up to 100% in those with locally advanced disease and older than 65 years. These results indicate the importance of RT as a modality of treatment of invasive cervical cancer in Brazil, where a substantial proportion of the diagnoses are made in advanced stages. This set of information regarding this important center may help the long-term strategic planning and the allocation of funds that enable the high demand to be met in an optimized manner.