Effect of concurrent intra-arterial infusion of platinum drugs for patients with stage III or IV uterine cervical cancer treated with radical radiation therapy

PURPOSE The purpose of this study was to explore the effect of concurrent intra-art erial infusion of platinum drugs in patients with stage III or IV uterine c ervical cancer treated with radical radiation therapy. PATIENTS AND METHODS Thiry-three patients with advanced (stage IIIA, 2; IIIB, 28; IVA, 3) uterin e cervical squamous cell carcinoma were randomized into a concurrent intra- arterial infusion of platinum drugs with radiation therapy (IAPRT) group (1 8 patients) and a radiation therapy alone group (15 patients). After alteri ng intrapelvic blood how by embolization of the superior and inferior glute al arteries under pelvic angiography, intra-arterial infusion of platinum d rug through catheters inserted into both internal iliac arteries uas perfor med concurrently with radiation therapy. One-shot infusion of cisplatin (10 0 mg/m(2)) twice with a 2- to 3-week interval was performed in eight patien ts, weekly infusion of carboplatin (100 mg/m(2)) via a reservoir five to si x times was performed in four patients, and daily shot of cisplatin (10 mg/ body) or 21 days via a reservoir was performed in six patients. Radiation t herapy consisted of external-beam irradiation of 50 Gy/25 fractions/5 weeks for the whole pelvis with midline block after 30 Gy and intracavitary high -dose-rate brachytherapy using tandem and ovoids of 24 Gy/4 fractions/4 wee ks to point A. RESULTS The local complete response rate of the IAPRT group was 94% and was signifi cantly higher than that of the radiation therapy group (67%). There were no significant differences in local response in the three drug delivery metho ds. Two- and 5-year overall survival rates were 54.5% and 44.4% in the IAPR T group, and 74.5% and 50.0% in the radiation therapy group, respectively. There was no significant difference between the two groups. In the IAPRT gr oup, grade 3 or 4 acute bowel complications were seen in 33% of patients, g rade 3 or 4 late bo bowel complications were seen 44%, and grade 3 or 4 mye losuppression was seen in 33%, and these complications were seen more in th e IAPRT group than in the radiation therapy group and caused death in some patients. CONCLUSIONS IAPRT had a better local response than radiation therapy but showed no proo f of control over recurrence and had a poorer survival than radiation thera py. There were many local recurrences and distant metastases, contrary to t he better first response of the IAPRT group over the radiation therapy grou p. Complications of the IAPRT group mere very severe and made the patient's performance status and prognosis worse than in the radiation therapy group . We need to design some methods to decrease these complications to make us e of the good local response acquired with IAPRT. Furthermore, we should re -examine the indication of IAPRT in patients with a large tumor because loc al recurrence and distant metastasis would be inevitable.