Concurrent carboplatin/5-fluorouracil and radiotherapy for recurrent cervical carcinoma

Background: Results of salvage therapy in patients with carcinoma of the ut erine cervix recurrent after surgery have been dismal even when the disease was apparently confined to the pelvis. Concurrent chemoradiation is one of the several avenues being investigated to improve these results. Patients and methods: Thirty-five women with recurrent cervical carcinoma w ere enrolled in the trial. Twenty-eight patients (80%) had disease limited to the central pelvis (ten), lateral pelvis (fourteen) and vagina (four) an d seven had paraortic metastases. Patients were treated with a combination of external radiotherapy (50-70 Gy) along with three cycles of 5-fluorourac il (1000 mg/m(2)/24-hour continuous infusion days 1-4) and carboplatin (75 mg/m(2) in bolus days 1-4). Results: Treatment was well tolerated, with 30 patients (86%) completing th e protocol as planned. Acute toxicity was severe but manageable; 11 patient s (31%) experienced grades 3-4 acute toxicity. Late morbidity occurred in f ive patients (14%). Overall response rate was 74% (11 partial responses and 15 complete). After a median follow-up of 27 months (range 18-90), 13 pati ents (37%) are alive without disease, 4 (11%) are alive with persistent dis ease and 18 (52%) are dead of their disease. Actuarial two-year survival ra te for the series as a whole is 44% and three-year survival is 25%. Stage o f the primary disease, site of recurrence, interval from the primary therap y to recurrence, lymph node involvement, ureterohydronephrosis at the time of recurrence and diameter of the relapse are the most significant factors for survival, while complete response is related to diameter and site of re lapse and lymph node status at the time of relapse. Conclusion: The acceptable toxicity, high response rate and satisfying surv ival would suggest that concomitant carboplatin/5-fluorouracil and radiothe rapy is a safe and tolerable treatment for recurrent cervical carcinoma. Fu rther studies are needed to demonstrate an eventual survival benefit of thi s type of chemoradiation over standard radiotherapy alone and to identify t he subsets of patients who in particular might benefit from this.