A phase I II study of combined weekly systemic cisplatin and locoregional hyperthermia in patients with previously irradiated recurrent carcinoma of the uterine cervix
R. De Wit et al., A phase I II study of combined weekly systemic cisplatin and locoregional hyperthermia in patients with previously irradiated recurrent carcinoma of the uterine cervix, BR J CANC, 80(9), 1999, pp. 1387-1391
We investigated the feasibility and the anti-tumour activity of weekly cisp
latin and the simultaneous application of local hyperthermia in patients wi
th a pelvic recurrence of cervical cancer in previously irradiated area. Do
se levels of cisplatin 60 mg m(-2), 70 mg m(-2) and 80 mg m(-2) were studie
d. Treatment objective of hyperthermia was the achievement of a tumour temp
erature of greater than or equal to 42 degrees for 60 min, during cisplatin
administration. The protocol advised six weekly cycles of combined treatme
nt. Nineteen patients, median age 47 years (range 26-71), were treated. A t
otal of 89 cycles of combined treatment were administered. Even at the high
est dose level of cisplatin, 80 mg m(-2) weekly, no dose-limiting toxicity
was observed. Leucocytopenia at scheduled retreatment resulted in 1 or 2 we
eks postponement in five cases. Neurotoxicity and renal toxicity were mild
or absent. Maximum tumour temperatures achieved ranged 39.7-43.6 degrees C,
mean 41.6 +/- 0.7 degrees C. All 19 patients were evaluable for response.
One patient achieved a complete response that lasted 20 months, and nine pa
tients achieved a partial response for a median duration of 6 months (range
4-50+ months), for an overall response rate of 53%. One patient subsequent
ly underwent salvage surgery and currently remains free of disease at 4 yea
rs. We found that this combined hyperthermia-dose-intensive cisplatin regim
en was well-tolerated. The true impact of the combination of cisplatin and
locoregional hyperthermia can only be answered in a randomized study. Nonet
heless, based on existing data on the poor efficacy of cisplatin in pelvic
recurrent cervical cancer, we believe that the combined modality approach o
f weekly hyperthermia plus dose-intensive cisplatin is an attractive regime
n, particularly if subsequent salvage surgery is available.