Weekly cisplatin plus external beam radiotherapy and high dose rate brachytherapy in patients with locally advanced carcinoma of the cervix

Chemoradiation in Cervical Cancer with Cisplatin and High-Dose Rate Brachytherapy Combined with External Beam Radiotherapy

“…The relatively low frequencies of acute and chronic side effects of cisplatin chemoradiation in our study were also observed in other phase-II studies and in the cisplatin chemoradiation arms of the randomized GOG studies 120 and 123, in which brachytherapy was always delivered by means of LDR applications as is shown in Table 4 [4,12,13,17,23,24]. In no case during our phase-II study did a course of radiation therapy have to be interrupted or discontinued for acute side effects, a factor which is a prerequisite for an optimal therapeutic effect.…”

“…One of these two patients did not undergo brachytherapy and the other received a high-dose rate brachytherapy with 2 ϫ 5 Gy. The high rate of severe gastrointestinal late complications, which was reported by Souhami et al [24] in their phase-I/II study using a HDR brachytherapy, has not yet been observed in the course of our study. All of the patients enrolled in our phase-II study continue to be followed up at our center especially with regard to any late complications of chemoradiation.…”

“…Moreover, the results of a phase-I/II study in 1993 suggested that a simultaneous course of cisplatin chemoradiation and high-dose rate brachytherapy appears to be associated with a high rate of G3 or G4 late toxicities [24]. 13 of 50 patients (26%) in this study showed such severe late sequelae of therapy, most of which were bowel complications.…”

“…The weekly cisplatin dose was 30 mg/m 2 . The acute toxicity in the study of Souhami et al [24] was only low in one patient given the occurrence of a G3 leukocytopenia. The median onset of severe late sequelae in the cited study appeared already 11 months after therapy.…”

“…As against that, Souhami et al [24] 1993 reported an unacceptable high rate of G3/G4 late sequelae in a phase-I/II study with percutaneous radiation fractions of 2 Gy and a concurrent dose of 30 mg/m 2 cisplatin weekly and a subsequent highdose rate (HDR) brachytherapy [24]. While a complete clinical remission was achieved in 88% of 50 patients in stages IIA-IV, including 50% in stage IIIB, serious late bowel complications occurred in 13 patients (26%) a median 11 months after radiation, which the authors only observed in 7.5% of cases undergoing radiation alone according to this plan.…”