TREATMENT OF CARCINOMA OF THE UTERINE CERVIX WITH CONCOMITANT CISPLATIN, 5-FLUOROURACIL AND SPLIT COURSE HYPERFRACTIONATED RADIOTHERAPY

To improve local and systemic control of bulky (>4 cm) and/or advanced primary cancer of the uterine cervix, 35 patients were treated with c oncomitant cisplatin (CDDP), 5-fluorouracil (5-FU) and split course hy perfractionated radiotherapy. Radiation was administered to the pelvis in five-day courses at a dose of 1.5 Gy twice daily every 21 days unt il a median dose of 45 Gy was reached. 15 Gy more were administered to involved parametrium or central tumor by external radiotherapy or bra chytherapy. The irradiated zone was extended to include paraaortic lym ph nodes if necessary. CDDP was administered at a dose of 20 mg m(-2) and 5 FU at a dose of 500 mg m(-2) from day one to day five of each co urse. The median number of combined treatment courses per patient was four (1-6). Local responses were obtained in 19 out of 24 patients in whom evaluation was feasible (i.e. who did not undergo surgery prior t o combined therapy). Median survival was not attained with a median fo llow up of 33 months, three year overall survival was 62% and 52% in p atients with local control and in the whole population respectively. S everal patients with stage III and IV tumors achieved a very long surv ival. Acute toxicity was manageable but three patients required surgic al repair of late radiation complications. This combined chemotherapy and radiotherapy resulted in good local control and did not rule out s urgery. (C) 1998 Elsevier Science Ireland Ltd.