M. Morris et al., Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer, N ENG J MED, 340(15), 1999, pp. 1137-1143
Citations number
32
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background and Methods We compared the effect of radiotherapy to a pelvic a
nd para-aortic field with that of pelvic radiation and concurrent chemother
apy with fluorouracil and cisplatin in women with advanced cervical cancer.
Between 1990 and 1997, 403 women with advanced cervical cancer confined to
the pelvis (stages IIB through IVA or stage IB or IIA with a tumor diamete
r of at least 5 cm or involvement of pelvic lymph nodes) were randomly assi
gned to receive either 45 Gy of radiation to the pelvis and para-aortic lym
ph nodes or 45 Gy of radiation to the pelvis alone plus two cycles of fluor
ouracil and cisplatin (days 1 through 5 and days 22 through 26 of radiation
). Patients were then to receive one or two applications of low-dose-rate i
ntracavitary radiation, with a third cycle of chemotherapy planned for the
second intracavitary procedure in the combined-therapy group.
Results Of the 403 eligible patients, 193 in each group could be evaluated.
The median duration of follow-up was 43 months. Estimated cumulative rates
of survival at five years were 73 percent among patients treated with radi
otherapy and chemotherapy and 58 percent among patients treated with radiot
herapy alone (P=0.004). Cumulative rates of disease free survival at five y
ears were 67 percent among patients in the combined-therapy group and 40 pe
rcent among patients in the radiotherapy group (P<0.001). The rates of both
distant metastases (P<0.001) and locoregional recurrences (P<0.001) were s
ignificantly higher among patients treated with radiotherapy alone. The ser
iousness of side effects was similar in the two groups, with a higher rate
of reversible hematologic effects in the combined-therapy group.
Conclusions The addition of chemotherapy with fluorouracil and cisplatin to
treatment with external-beam and intracavitary radiation significantly imp
roved survival among women with locally advanced cervical cancer. (N Engl J
Med 1999;340:1137-43.) (C)1999, Massachusetts Medical Society.