Phase I trial of concomitant chemoradiotherapy for cervical cancer and other advanced pelvic malignancies

Purpose. The aim of this study was to determine the feasibility and toxicit y of concomitant hydroxyurea (HU) and escalating doses of 5-fluorouracil (5 -FU) in locally advanced cervical cancer and other pelvic malignancies unde rgoing radiation therapy (RT). Methods. Treatment consisted of 5-FU, HU, and pelvic RT delivered in an alt ernate-week fashion. 5-FU was administered as a continuous intravenous infu sion at a starting dose of 600 mg/m(2)/day and was escalated to 1000 mg/m(2 )/day in cohorts of three patients. The HU dose was 500 mg twice daily. Che moradiotherapy was administered on a 5-day cycle. Following a 9-day rest, t he cycle was repeated until the completion of the pelvic RT. Results. Twenty-one patients (18 cervix, 1 bladder, 1 vagina, 1 ovary) were enrolled. 5-FU escalation to 1000 mg/m(2)/day was well tolerated. No patie nts developed grade 3-4 hematologic toxicity. Grade 2 leukopenia was noted in 3 patients (14.3%). Grade 3 mucositis, diarrhea, and dermatitis occurred in 10, 10, and 5% of patients, respectively. None of the 99 treatment cycl es were delayed secondary to acute toxicity. The overall response rate in t he 18 cervical cancer patients was 89% (78% complete, 11% partial). Conclusions. Concomitant continuous infusion 5-FU, twice daily HU, and pelv ic RT delivered in an alternate-week fashion is well tolerated. Further stu dy is necessary to evaluate the therapeutic efficacy of this regimen in pat ients with advanced cervical and other pelvic malignancies. (C) 1999 Academ ic Press.