Treatment of advanced and recurrent squamous carcinoma of the uterine cervix with constant intraarterial infusion of cisplatin

Abstract

Twelve patients with primary or locally recurrent squamous carcinoma of the cervix were treated with constant internal iliac artery infusion of cisplatin (CDDP) via a totally implantable chemotherapy pump. Seven previously untreated patients received standard external and interstitial radiotherapy (RT) in conjunction with CDDP infusion. Five patients with isolated pelvic recurrences received CDDP therapy only. The chemotherapy pump was refilled weekly on an outpatient basis. All nine evaluable patients developed unilateral or bilateral lower extremity pain which responded to dosage reduction. No renal or marrow toxicity was seen. Both of the evaluable patients treated for recurrent tumor died 32 and 60 weeks after initiation of treatment. The seven patients treated primarily with RT + CDDP infusion include one who expired with persistent tumor and one with no evidence of disease (NED) after exenteration for a pelvic recurrence at 48 and 85 weeks respectively. The five remaining patients are NED at 12 to 60 weeks. Constant internal iliac artery infusion of CDDP via an implantable chemotherapy pump can be performed with acceptable toxicity. The preliminary results suggest that further study in previously untreated undergoing concurrent radiotherapy is warranted.

Concurrent Cisplatin-Based Radiotherapy and Chemotherapy for Locally Advanced Cervical Cancer

“…16,18,[32][33][34][35][36][37][38][39][40] Two trials reported improvements in local control of tumors and survival in pa-*A grade of 0 indicates the absence of an adverse effect, a grade of 1 a minimal effect, a grade of 2 a mild effect, a grade of 3 a moderate effect, and a grade of 4 a severe effect. Eight patients who did not receive radiotherapy were excluded from the analysis.…”

Continuous intra-arterial cisplatin combined with radiotherapy in locally advanced squamous carcinoma of the cervix: a Gynecologic Oncology Group pilot study

“…A continuous intra-arterial infusion of cisplatin during the entire course of radiotherapy might be superior to intermittent boluses every 3-4 weeks, based on in vitro evidence (12). Rettenmaier et al (13) reported continuous low dose cisplatin delivered to the internal iliac arteries through a totally implantable pump in 12 patients with locally advanced carcinoma of the cervix. Seven of these patients were treated primarily, and five maintained local control over a short follow-up period.…”

“…The majority of the patients did not receive the planned amount of cisplatin, and drug distribution was not appropriate through 46% of the catheters. Rettenmaier et al (13) did not evaluate distribution through the pump catheters. However, (26)(27)(28).…”

Radiotherapeutic management in carcinoma of the uterine cervix: current status

“…This could be an unfavorable factor because the vascular supply to the tumor site after surgery and especially radiation therapy may be compromised. Recently, the technical difficulties of intra-arterial drug administration have been overcome by an implantable delivery system which minimizes the risk of infection and the requirement for multiple invasive procedures to secure vascular access (67). Therefore, further study with this combination method as a part of sequential therapeutic plan with surgery and/or radiotherapy is warranted (6s'69).…”