Concurrent Chemotherapy and Pelvic Radiation Therapy Compared With Pelvic Radiation Therapy Alone as Adjuvant Therapy After Radical Surgery in High-Risk Early-Stage Cancer of the Cervix

Peters, William A.; Liu, P. Y.; Barrett, Rolland J.; Stock, Richard J.; Monk, Bradley J.; Berek, Jonathan S.; Souhami, Luís; Grigsby, Perry W.; Gordon, William; Alberts, David S.

doi:10.1097/00006254-200008000-00017

Cited by 445 publications

(691 citation statements)

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Section: Discussionmentioning

confidence: 99%

“…Two trials of additional chemotherapy given after chemoradiotherapy [24] or surgery and postoperative chemoradiotherapy [23] show a marked survival advantage. In the SWOG trial [23], this advantage appeared more pronounced in the patients who received 3 or 4 cycles of chemotherapy. A re-analysis of more mature data in 2005 [53] showed maximal benefit for patients with spread to 2 or more lymph nodes following postoperative radiotherapy and adjuvant chemotherapy compared to those receiving only postoperative radiotherapy (5-year survival 55% versus 75%).…”

Section: Discussionmentioning

confidence: 99%

“…Although not all relevant trials were included (Table 3), the most recent presentation was based on data from 17 trials and 4638 women [21]. Excluding the trial that gave extended-field radiotherapy [11]; [22] or hydroxyurea [12]; [14] on the control arm or additional chemotherapy in the treatment arm [15]; [23]; [24] thereby leaving only the trials that compared chemoradiotherapy with the same radiotherapy, there was a 21% relative reduction in the risk of death (HR=0.79, 95% CI=0.70-0.90, p=0.0003). This is equivalent to a 7% absolute improvement in 5-year survival.…”

Section: Other Cytotoxic Chemotherapymentioning

confidence: 99%

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Concomitant and Neoadjuvant Chemotherapy for Cervical Cancer

Tierney¹,

Vale²,

Symonds³

2008

Clinical Oncology

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In the past, women with early stage cervical cancer have been treated with radical radiotherapy or radical surgery, and women with locally advanced disease with radical radiotherapy, each offering a good chance of cure. Numerous trials have investigated whether giving cytotoxic chemotherapy alongside radiotherapy or prior to local treatment could augment the established benefits of these therapies, and are reviewed here. There is a strong basis for the use of platinum-based chemoradiotherapy, the current standard of care, but little convincing evidence as to the therapeutic benefits of using concomitant hydroxyurea. Chemoradiotherapy based on other non-platinum agents may offer alternatives. The effect of chemoradiotherapy appears to vary according to the stage of disease, but all types of women benefit. Neoadjuvant chemotherapy prior to radiotherapy could jeopardise survival and should be avoided unless perhaps a 'quick', dose intense regimen is used. Neoadjuvant chemotherapy before surgery may be beneficial, but the approach will remain controversial until it is tested against platinum-based chemoradiotherapy. Future studies many include combinations of other cytotoxics such as topotecan with cisplatin-based concomitant chemoradiotherapy or the addition of agents targeted against specific receptors such as EGFR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Other Cytotoxic Chemotherapymentioning

confidence: 99%

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Concomitant and Neoadjuvant Chemotherapy for Cervical Cancer

Tierney¹,

Vale²,

Symonds³

2008

Clinical Oncology

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“…[32][33][34] The survival rates for these patients following either surgery or irradiation therapy have been shown to be 74-93%. 34 In younger women, such as those who might be coincidentally pregnant, surgical management may be preferred to irradiation because the ovaries can be retained to preserve both hormonal and surrogateassisted reproductive function.…”

Section: Stage Ib1mentioning

confidence: 99%

Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease

Hunter

Tewari

Monk

2008

American Journal of Obstetrics and Gynecology

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“…A new standard for the treatment of locally advanced cervical cancer was established in 1999 [4,5]. The addition of weekly cisplatin at 40 mg/m 2 for 6 weeks in combination with radiation (RT) reduces the relative risk of death from cervical cancer by approximately 50% by decreasing local failure and distant metastases [6][7][8][9][10]. This combination was favored because Gynecologic Oncology Group (GOG) Protocol 120 showed it to be less toxic and as equally efficacious when compared with other combinations using hydroxyurea and/or 5-flourouracil (5-FU) [8].…”

Section: Introductionmentioning

confidence: 99%

A feasibility study of topotecan with standard-dose cisplatin and concurrent primary radiation therapy in locally advanced cervical cancer

Gatcliffe

Tewari

Shah

et al. 2009

Gynecologic Oncology

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Objectives. Topotecan improves response rate (RR), progression-free survival (PFS) and overall survival (OS) when added to cisplatin in treating metastatic and recurrent cervical cancer. The objective of this study was to assess the feasibility of adding weekly topotecan to cisplatin in patients with primary, locally advanced carcinoma of the cervix receiving pelvic irradiation.Methods. Patients with primary, previously untreated, histologically confirmed invasive squamous cell, adenocarcinoma, or adenosquamous carcinoma of the uterine cervix, stages IB2-IVA were treated with external beam pelvic radiotherapy (45 Gy), intracavitary low dose rate brachytherapy (40 Gy) and a parametrial boost (5.4-9 Gy) with overall treatment time not to exceed 8 weeks. Concurrent chemotherapy was IV cisplatin 40 mg/m 2 plus IV topotecan 2 mg/m 2 on days 1, 8, 15, 22, 29 and once during parametrial boost for 6 cycles. Patients were monitored with history, physical examination, tumor measurement and laboratory evaluation before entering the study, before each cycle of chemotherapy, at study termination and every three months thereafter.Results. The study met its accrual goal of 12 patients. With a median follow-up of 22 months, eleven patients completed treatment and ten are in long term follow up without evidence of recurrent disease. The 12th patient developed progressive disease during therapy. All patients completed at least 4 cycles of chemotherapy, with the majority (82%) completing 5 or more. Grade 2 or higher neutropenia delayed treatment in 54% of cycles. The median treatment delay was 1.5 cycles (range: 1 to 5 cycles). Median treatment time was 59 days (range 46 to 81 days). The complete RR was 92% (95% confidence interval, 55%-100%).Conclusions. The addition of weekly topotecan to cisplatin at this dose and schedule during pelvic irradiation for locally advanced cervical cancer appears to be feasible. Based on this primary treatment data and the activity of cisplatin-topotecan in the recurrent disease setting, phase II and III studies of this combination are warranted.

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Concurrent Chemotherapy and Pelvic Radiation Therapy Compared With Pelvic Radiation Therapy Alone as Adjuvant Therapy After Radical Surgery in High-Risk Early-Stage Cancer of the Cervix

Cited by 445 publications

References 0 publications

Concomitant and Neoadjuvant Chemotherapy for Cervical Cancer

Concomitant and Neoadjuvant Chemotherapy for Cervical Cancer

Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease

A feasibility study of topotecan with standard-dose cisplatin and concurrent primary radiation therapy in locally advanced cervical cancer

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