A PILOT-STUDY ON CONCURRENT PLATINUM CHEMOTHERAPY AND INTRACAVITARY BRACHYTHERAPY FOR LOCALLY ADVANCED CANCER OF THE UTERINE CERVIX

This study aims to evaluate the feasibility, toxicity and efficacy of concurrent chemotherapy with platinum compounds and brachytherapy, for locally advanced carcinoma of the cervix (Stages IIA/B, IIIA). The hy pothesis was that synchronous chemo-brachytherapy may be sufficient to cause down-staging of the tumour, to render it operable, and hopefull y improve the prognosis. 36 women with locally advanced cervical cance r were treated with concomitant brachytherapy and chemotherapy before surgery and/or definitive external radiotherapy All patients received two caesium-137 Selectron MDR applications, 1 week apart. The dose cal culated to point A for each implant was 20-25 Gy. Chemotherapy consist ing of continuous cisplatin infusion (50 mg m(2)) and of carboplatin ( 300 mg m(-2)) was given simultaneously with intracavitary irradiation during the first and second application, respectively. The combined th erapy was followed when feasible by radical hysterectomy, pelvic lymph adenectomy and pelvic radiotherapy. Patients deemed ineligible for sur gery because of poor response were given full dose external radiothera py. 31/36 patients were treated by Wertheim hysterectomy of whom 10 ha d negative lymph nodes and resection margins. Definitive external radi otherapy was given in the remaining five patients. Overall, 83% were d isease free at 2.8 years mean follow-up. The most frequent acute side- effects of chemo-brachytherapy were nausea and vomiting. No renal toxi city was observed. Thrombocytopenia was seen in five patients and was responsible for delayed surgery in four patients. Concerning late effe cts, two patients developed grade 2 intestinal sequelae, two mild freq uency and two vaginal stenosis. One rectovaginal and one vesicovaginal fistula developed in two patients; and a third patient had a fistula associated with tumour recurrence. Concurrent brachytherapy and chemot herapy with platinum compounds is well tolerated and effective in redu cing tumour bulk before definitive local treatment (surgery or externa l radiotherapy), in patients with locally advanced carcinoma of the ut erine cervix.