Randomized Comparison of Fluorouracil Plus Cisplatin Versus Hydroxyurea as an Adjunct to Radiation Therapy in Stage IIB-IVA Carcinoma of the Cervix With Negative Para-Aortic Lymph Nodes: A Gynecologic Oncology Group and Southwest Oncology Group Study

Whitney, Charles W.; Sause, William T.; Bundy, Brian N.; Malfetano, John H.; Hannigan, Edward V.; Fowler, Wesley C.; Clarke‐Pearson, Daniel L.; Liao, Shu-Yuan

doi:10.1200/jco.1999.17.5.1339

Cited by 1,374 publications

(784 citation statements)

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“…In recent years, several groups have reported concurrent chemoradiation to improve the survival of patients with locally advanced cervical carcinoma (Keys et al, 1999;Morris et al, 1999;Rose et al, 1999;Whitney et al, 1999;Peters et al, 2000). Cisplatin is the most active cytotoxic agent against cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

“…In the past few years, substantial advances in the management of locally advanced cervical cancer have been reported. Five randomised trials showed improved survival and local control when cisplatin-based chemotherapy was added concurrently to radiation treatment in patients with locally advanced cervical cancer (Keys et al, 1999;Morris et al, 1999;Rose et al, 1999;Whitney et al, 1999;Peters et al, 2000). This combined modality approach produced an absolute increase in 5-year survival of 12% as compared with radiation therapy alone and resulted in a sudden change in the standard of care for this disease.…”

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confidence: 99%

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Treatment of squamous cell carcinoma of the uterine cervix with radiation therapy alone: long-term survival, late complications, and incidence of second cancers

et al. 2007

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The objective of this retrospective study was to determine the survival rate, incidence of late complications, and incidence of second cancers when radiation therapy alone is used for carcinoma of the uterine cervix. Between 1971 and 1995, 1495 patients with squamous cell carcinoma of the uterine cervix (stages I -IV) were treated with radiation therapy alone in our hospital. Radiation therapy consisted of a combination of high-dose-rate intracavitary brachytherapy and external beam radiotherapy. The cumulative 5-year survival rates for stages Ib, II, and III/IVa carcinoma were 93.5, 77.0, and 60.3%, respectively, and the 10-year survival rates were 90.9, 74.5, and 56.1%, respectively. Local control rates for stages Ib, II, and III/IVa carcinoma were 92.0, 79.4 and 64.2%, respectively. Eighty-two (5.5%) patients suffered grade III/IV or V (fatal) complications. A second cancer developed in 13 (0.87%) patients. Second cancers were observed most frequently in the rectum (five cases), colon (three cases), and uterine body (two cases). Long-term follow-up data revealed that our method of radiation therapy alone for locally advanced carcinoma of the uterine cervix is effective, with low incidences of late complications and second cancers.

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Section: Discussionmentioning

confidence: 99%

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Treatment of squamous cell carcinoma of the uterine cervix with radiation therapy alone: long-term survival, late complications, and incidence of second cancers

et al. 2007

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“…In 1999, the National Cancer Institute recommended CCRT as the standard approach for locally advanced cervical cancer, based on a 30-50% decrease in mortality (7)(8)(9)(10). In Europe, Japan and Latin countries, NAC followed by surgery (NCS) has emerged as a valid alternative and several pilot studies have shown a large benefit over RT alone in terms of overall survival (OS) and disease-free survival (DFS) (11).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemotherapy for locally advanced cervical cancer

2003

European Journal of Cancer

265

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Neoadjuvant chemotherapy followed by surgery (NCS) has not been fully evaluated clinically. Currently, the main regimen of neoadjuvant chemotherapy (NAC) used in NCS includes cisplatin. The antitumor effects of NAC reduce lymph node metastasis and the tumor diameter in patients prior to surgery, and this can reduce the number of high risk patients who require postoperative radiation therapy. Many randomized controlled trials (RCTs) have examined the long-term prognosis of NCS compared to primary surgery, but the utility of NCS remains uncertain. The advent of concurrent chemoradiotherapy (CCRT) has markedly improved the outcome of radiotherapy (RT), and CCRT is now used as a standard method in many cases of advanced bulky cervical cancer. NCS gives a better treatment outcome than radiation therapy alone, but it is important to verify that NCS gives a similar or better outcome compared to CCRT.

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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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Randomized Comparison of Fluorouracil Plus Cisplatin Versus Hydroxyurea as an Adjunct to Radiation Therapy in Stage IIB-IVA Carcinoma of the Cervix With Negative Para-Aortic Lymph Nodes: A Gynecologic Oncology Group and Southwest Oncology Group Study

Abstract: This study demonstrates that for patients with locally advanced carcinoma of the cervix, the combination of 5-FU and CF with RT offers patients better PFS and overall survival than HU, and with manageable toxicity.

Cited by 1,374 publications

References 56 publications

Treatment of squamous cell carcinoma of the uterine cervix with radiation therapy alone: long-term survival, late complications, and incidence of second cancers

Treatment of squamous cell carcinoma of the uterine cervix with radiation therapy alone: long-term survival, late complications, and incidence of second cancers

Neoadjuvant chemotherapy for locally advanced cervical cancer

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

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