CONCOMITANT CHEMOTHERAPY AND RADIOTHERAPY IN THE TREATMENT OF ADVANCED CERVIX CARCINOMAS

The pelvis is a major site of failure in patients with advanced carcin oma of the cervix. Attempting to improve local disease control, 40 pat ients were treated between February 1988 and July 1992 with concurrent chemoradiation (CCR). Thirty three patients (group A) with bulky cerv ical tumors (> 5 cm) received this CCR as the first part of their trea tment (stages IB: IIB with distal parametrial involvement: 14; IV: 15) . CCR was followed by brachytherapy and a parametrial boost if indicat ed, then by surgery. CCR was also given, as a post-operative treatment , in seven patients (group B) with a bulky nodal involvement on a prev ious hysterectomy with lymphadenectomy performed for an early stage. C CR was a pelvic radiation therapy (RT): 45 Gy/25 F/33 d (two fractions per day in the last 14 patients) and a chemotherapy delivering: CDDP 60 mg/m(2) on days 1 and 21, followed by 5-FU 600 mg/m(2) iv continuou s infusion for 96 hours (respectively 40 and 400 mg/m(2) in the 16 las t patients). Median follow-up is 35 months (range 10-63 m). Acute toxi cities were grade 3-4 diarrhea in 16 patients and another patient died from a septic episode without leucopenia after CCR. Five post-operati ve complications required a second surgical procedure. Among these fiv e patients, one died and two other developed small bowel late complica tions. No post-operative or late complication were observed in patient s treated with a bi-fractionated RT. Sites of failure were: pelvic: fo ur; metastases: five, both: three. Thirty months survival and DFS rate s were 67,5% and 58,4% in the whole series and respectively 64% and 52 ,5% in stages IB-IIB patients and 63% and 59% in stage IV patients. Su rgery is an important factor of the treatment and a CCR with a bi-frac tionated RT allows such a surgical procedure. These encouraging result s must be confirmed by a prospective study to determine wheter a CCR i s able to improve local control and survival.