Background
Despite the current standard of concurrent chemoradiation (CCRT), around 30–40% are still dying from locally advanced cervical cancer. Increasing the radiation dose further was not a feasible option, but addition of chemotherapy further was tried due to the different toxicity profiles of it. So, the use of consolidation chemotherapy beyond CCRT has been studied.
Aim
To evaluate the efficacy, toxicity, tumour response and loco-regional control following consolidation chemotherapy after concurrent chemoradiation in locally advanced carcinoma cervix (LACC).
Methods
The patients were randomized into two arms: the conventional arm (control arm,
n
= 30) patients received conventional treatment with weekly injection cisplatin (35 mg/m
2
) concurrently with pelvic external beam radiation (50 Gy/25 fraction, 2 Gy/fraction, 5 fraction weekly) followed by intracavitary radiotherapy of 21 Gy in 3 fractions of 7 Gy each by HDR brachytherapy. In the interventional arm (study arm,
n
= 30), patients received the standard treatment followed by 3 cycles of consolidation chemotherapy (paclitaxel + carboplatin) every three weekly.
Results
Haematological toxicity (grade 3 anaemia and grade 1 leucopenia, grade 1 and 2 thrombocytopenia) was higher in the study group. Renal, hepatic and gastrointestinal toxicity was more in the study arm. Peripheral neuropathy was mostly seen in the study arm. Median follow-up was 9 months. Treatment response was better, and the rate of recurrence was less in the study arm.
Conclusion
Addition of few cycles of consolidation chemotherapy after standard treatment is beneficial in patients with LACC with manageable toxicity and good compliance.
Purpose-
To evaluate and compare the safety and efficacy of 60 Gy versus 50 Gy dose radiotherapy with concurrent chemotherapy in locally advanced unresectable oesophageal cancer.
Methods-
Study design was prospective, randomized and comparative. 60 Patients (30 patients in each arm) with histologically proven locally advanced unresectable oesophageal carcinoma and with good balance in observed co-variables were enrolled. Total radiation dose of 60 Gy was given in one arm while 50 Gy in another arm. Weekly CCRT was given till radiotherapy treatment completion in both the arms with paclitaxel 75 mg/m2 and carboplatin AUC 2. Statistical analysis was done using SPSS version 2.0. At 4 weeks of completion of treatment and after 6 months follow-up, response was assessed using RECIST (1.1) criteria.
Results-
In 60 Gy dose arm, 76.66% patients and in 50 Gy arm, 70% patients achieved CR but the difference was statistically non- significant (p= 0.559). After 6 months of median follow up, 60% patients in 60 Gy arm and 50% in 50 Gy arm had CR whereas 30% patients in 60 Gy arm and 40% in 50 Gy arm had LRF. There were no statistically significant differences between the two arms in leucopenia (p=0.576), nephrotoxicity (p=1.0), radiation dermatitis (p=0.615), vomiting (p=0.921) and diarrhoea (p=1.0).
Conclusion-
60 Gy dose radiotherapy with concurrent chemotherapy can be used feasibly and safely with only a few manageable side effects and with favourable benefit-risk profile, especially in terms of local tumour control. However, to validate this conclusion, large sample size and longer follow-up will be required.
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