Department of radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Objectives. This prospective study was carried out to evaluate the results of chemo radiation (CRT) in the treatment of locally advanced carcinoma cervix and to compare with patients treated with radiotherapy (RT) alone.
Methods. Between 1996 and 2001, 57 patients of carcinoma cervix (bulky > 4 cm clinically, stage IIB/III) were treated with CRT. External radiation 46 Gy/23 fractions was followed by brachytherapy 35 Gy to Point A. Cisplatin was given in a dose of 50mg /week concurrently with external radiation for 5 cycles. A non-randomized comparison of CRT was done with the same subset of patients treated with RT alone (895 pts) during the same period.
Results. Overall survival (OS), disease free survival (DFS) and pelvic control with CRT at 5 years (45.6 %, 43.9 % and 57.9 %) were similar to RT alone arm (47.4 %, 45.5 % and 61.3 %). Compared to RT alone arm, (11.6 %) severe acute toxicities (grade3 ≥, RTOG criteria) were significantly higher in CRT arm (31.6 %) (p < 0.001). More late rectal toxicities were encountered in CRT arm (22.8%) compared to RT alone (12.5 %) (p = 0.01), but the incidence of severe late rectal toxicities (≥ grade 3) were similar; 1.8 % in CRT versus 1.1 % in RT arm.
Conclusions. With CRT, there were no significant differences in the outcomes and the incidence of severe late toxicities compared to RT alone arm. As the patients in Indian subcontinent usually present in late stages with poor general condition, CRT should be used judiciously with careful attention given to patient selection with escalation of doses of cisplatin to get the optimal benefit.