INTRAARTERIAL CHEMOTHERAPY WITH CISPLATIN FOLLOWED BY RADICAL RADIOTHERAPY FOR LOCALLY ADVANCED CERVICAL-CANCER

Locally advanced cervical cancer has a dismal prognosis, with a high l ocal failure rate and a poor survival rate, To improve the cure rate f or advanced carcinoma of the cervix, we initiated a study of intra-art erial (I-A) chemotherapy with cisplatin via the uterine artery prior t o definitive radiotherapy, I-A chemotherapy via the internal iliac art ery has been used to treat advanced cervical cancer; however, access b y way of the uterine artery has not been tested for this purpose. Thir ty-four patients with central tumor greater than or equal to 5 cm in a nteroposterior diameter observed on CT scans were treated with I-A che motherapy, I-A chemotherapy consisted of unilateral catheterization of the uterine artery using 120 mg/m(2) cisplatin. After assessment of I -A chemotherapy, all but 3 patients were treated with a combination of whole-pelvis external irradiation and intracavitary irradiation, The 3 patients underwent external radiotherapy alone, Twenty-seven of 34 p atients treated were evaluable for response to I-A chemotherapy, Eleve n patients (41%) experienced a partial response, Seventy-six percent o f the 34 patients treated with I-A chemotherapy followed by radiothera py exhibited a complete response by the end of treatment, Toxicity was well tolerated and no death due to treatment occurred, The 2- and 5-y ear actuarial survival rates were 64 and 55%, respectively, The crude incidences of pelvic recurrence and distant metastasis observed at a m edian follow-up of 54 months were both 47%, This study for locally adv anced cervical cancer suggests there is benefit to be derived from our I-A chemotherapy followed by radical radiotherapy. (C) 1995 Academic Press, Inc.