MATURE RESULTS OF A PHASE-II TRIAL OF CONCOMITANT CISPLATIN PELVIC RADIOTHERAPY FOR LOCALLY ADVANCED SQUAMOUS-CELL CARCINOMA OF THE CERVIX/

Purpose: Patients with locally advanced squamous cell carcinoma of the cervix have a poor prognosis when treated by standard ratiotherapy (R T) alone. Factors such as large tumor volume or nodal disease result i n pelvic and distant treatment failures. Cisplatin (CDDP), a known rad iosensitizer with documented activity in squamous cell carcinomas; was used in a phase II prospective study to evaluate the efficacy of comb ined chemo/radiotherapy in locally advanced squamous cell carcinomas o f the cervix. Method: CDDP was administered (20 mg/m(2)) daily x 5 at 21-day intervals with concomitant external beam and intracavity RT. St andard RT was delivered at 1.8-2.0 Gy/day, 5 fractions per week for 5 weeks. Intracavitary cesium insertions were planned to treat point A t o approximately 80 Gy, Results: Fifty-nine patients were enrolled from March 1986 to July 1990. Four patients were voluntarily withdrawn, le aving 55 patients evaluable for response. Of these, 16 were Stage IB/I LA, 11 were Stage IIB, 24 were Stage III, and 4 were Stage IV. The med ian age of patients enrolled was 47 years (range 27-79). Median follow -up time was 65 months (range 60-113). Histopathologic confirmation of node status was available in 33 patients, of whom 45.5% (15/33) had n odal metastases. Overall response was 96% (CR = 87%, PR = 9.0%) and 3. 6% had progressive disease during treatment. Forty-six patients were e valuable at 5 years for overall and disease-free survival. Calculation s were based on Kaplan-Meier product limit estimates. The 5-year survi val was 73% for Stage IB/IIA, 60% for Stage IIB, 67% for Stage III, an d 25% for Stage IV. The disease-free survival at 5 years was 73% for S tage for IB/IIA, 50% for Stage IIB, 67% for Stage III, and 25% for Sta ge IV. Hematologic toxicity was severe but tolerable. No treatment-rel ated deaths occurred. Conclusion: Concomitant ant CDDP/RT is a safe an d tolerable method of treating patients with locally advanced squamous cell carcinoma of the cervix. Our data suggest a benefit in both dise ase-free and ii-year survival, particularly notable among patients wit h Stage III disease. (C) 1996 Academic Press, Inc.