Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix

Purpose: To determine whether the addition of cisplatin-based chemotherapy (CT) to pelvic radiation therapy (RT) will improve the survival of early-st age, high-risk patients with cervical carcinoma. Patients and Methods: Patients with clinical stage IA,IB, and IIA carcinoma of the cervix, initially treated with radical hysterectomy and pelvic lymp hadenectomy, and who had positive pelvic lymph nodes and/or positive margin s and/or microscopic involvement of the parametrium were eligible for this study, patients were randomized to receive PT or RT + CT. Patients in each group received 49.3 GY RT in 29 fractions to a standard pelvic field. Chemo therapy consisted of bolus cisplatin 70 mg/m(2) and a 96-hour infusion of f luorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles, with the first a nd second cycles given concurrent to RT. Results: Between 1991 and 1996, 268 patients were entered onto the study. T wo hundred forty-three patients were assessable (127 RT + CT patients and 1 16 RT patients), Progression-free and overall survival are significantly im proved in the patients receiving CT. The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm ar e 2.01 (P =.003) and 1.96 (P =.007), respectively. The projected progressio n-free survivals at 4 years is 63% with RT and 80% with RT + CT. The projec ted overall survival rate at 4 years is 71% with RT and 81% with RT + CT. G rades 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the PT + CT group. Conclusion: The addition of concurrent cisplatin-based CT to RT significant ly improves progression-free and overall survival for high-risk, early-stag e patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix. J Clin Oncol 18:1606-1613. (C) 2000 by American Society of Clinical Oncolog y.