Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 11 , ISSUE 1 ( January-February, 2019 ) > List of Articles


Comparison of Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Neoadjuvant Chemoradiation Followed by Radical Hysterectomy with Concurrent Chemoradiation in Locally Advanced Carcinoma Cervix (FIGO Stages IB2, IIA2, IIB): Interim Results of a Randomized Control Study

Syed A Hussain, Jagadeesan G Mani

Keywords : Brachytherapy, Locally advanced cervical cancers, Preoperative chemoradiotherapy, Randomized control trial, Toxicity profile, Quality of life

Citation Information : Hussain SA, Mani JG. Comparison of Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Neoadjuvant Chemoradiation Followed by Radical Hysterectomy with Concurrent Chemoradiation in Locally Advanced Carcinoma Cervix (FIGO Stages IB2, IIA2, IIB): Interim Results of a Randomized Control Study. J South Asian Feder Obs Gynae 2019; 11 (1):35-43.

DOI: 10.5005/jp-journals-10006-1647

License: CC BY-NC 4.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2019; The Author(s).


Objectives: To investigate the therapeutic efficacy, toxicity profile and quality of life in locally advanced cervical carcinoma treated with concurrent chemoradiation therapy (CCRT), preoperative chemoradiation (PCRT) and preoperative chemotherapy (PCHEMO) followed by surgical implications Materials and methods: A total of (N = 100) locally advanced cervical cancer patients (FIGO stages IB2, IIA2 and IIB) was treated between June 2014 to March 2018, Out of 100 patients, 33 patients treated with CCRT arm (50Gy EBRT and 21Gy brachytherapy), 33 patients treated with PCRT arm (50Gy EBRT) followed by radical hysterectomy, 34 patients with PCHEMO arm followed with radical hysterectomy using 3 weekly cisplatin (75 mg/m2 and paclitaxel (175 mg/m2). Patient's Quality life was recorded with a standard questionnaire. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 22. Results: The median follow-up period was found to be 28 months. However less statistical significance was obtained between various parameters such as age, FIGO stage, performance status, perioperative morbidities, and symptoms scales among three arms (p > 0.05). 97%, 94%, 88% of overall response rates noted in CCRT, PCRT and PCHEMO arm patients respectively. But 55% and 24% of PCRT and PCHEMO arm patients had pathological complete responses with the significance of p = 0.0016. CCRT arm patients had a larger amount of symptom expertise, difficulties in sexual functioning and sexual agony Conclusion: We observed equivalent therapeutic response, better toxicity profile and better quality of life among the patients treated with PCRT arm than the standard CCRT arm patients. Clinical significance: This approach could be feasible in developing countries wherein brachytherapy resources are scarce.

PDF Share
  1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: Defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006;24: 2137.2150.
  2. Rajkumar R, Sankaranarayanan R, Esmi A, Jayaraman R, Cherian J, Parkin DM. Leads to cancer control based on cancer patterns in a rural population in South India. Cancer Causes Control 2000;11:433.439.
  3. Markman M. Chemoradiation in the management of cervix cancer: current status and future directions. Oncology 2013; 84:246-250.
  4. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global Cancer Statistics. CA Cancer J Clin 2011; 61:69-90.
  5. Rose PG. Concurrent chemoradiation for locally advanced carcinoma of the cervix: where are we in 2006? Ann Oncol 2006;17(Suppl. 10):x224-229.
  6. Chuang L, Kanis MJ, Miller B, Wright J, Small W, Creasman W. Treating locally advanced cervical cancer with concurrent chemoradiation without brachytherapy in low-resource countries. American Journal of Clinical Oncology. 2016 Feb
  7. Pignata S, Frezza P, Tramontana S, Perrone F, Tambaro R, Casella G, Ferrari E, Iodice F, De Vivo R, Ricchi P, Tramontana F. Phase I study with weekly cisplatin-paclitaxel and concurrent radiotherapy in patients with carcinoma of the cervix uteri. Annals of Oncology. 2000 Apr 1;11(4):455-459.
  8. Petera J, Odrá žka K, Frgala T, Špaček J. External beam radiotherapy and high-dose brachytherapy combined with cisplatin and paclitaxel in patients with advanced cervical carcinoma. Gynecologic Oncology. 2005 Nov 1;99(2):334-338.
  9. Prasad E, Viswanathan PN, Rangad VF, Pavamani S, Ram TS. Maximum tolerated dose and early response.results of a phase I trial of paclitaxel and cisplatin with radiation therapy in carcinoma of the cervix. Clin Oncol (R Coll Radiol) 2009; 21:488.493.
  10. Chen MD, Paley PJ, Potish RA, Twiggs LB. Phase I trial of taxol as a radiation sensitizer with cisplatin in advanced cervical cancer. Gynecol Oncol 1997; 67:131.136.
  11. Miglietta L, Franzone P, Centurioni MG, Boni L, Tacchini L, Cosso M, et al. A phase II trial with cisplatin.paclitaxel cytotoxic treatment and concurrent external and endocavitary radiation therapy in locally advanced or recurrent cervical cancer. Oncology 2006;70:19.24.
  12. DiSilvestro PA, Walker JL, Morrison A, Rose PG, Homesley H, Warshal D, et al. Radiation therapy with concomitant paclitaxel and cisplatin chemotherapy in cervical carcinoma limited to the pelvis: A phase I/II study of the Gynecologic Oncology Group. Gynecol Oncol 2006;103:1038.1042.
  13. Brunner TB, Grabenbauer GG, Klein P, Baum U, Papadopoulos T, Bautz W, et al. Phase I trial of strictly time-scheduled gemcitabine and cisplatin with concurrent radiotherapy in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2003;55:144-153.
  14. Zarba JJ, Jaremtchuk AV, Gonzalez Jazey P, Keropian M, Castagnino R, Mina C, et al. A phase I.II study ofweekly cisplatin and gemcitabine with concurrent radiotherapy in locally advanced cervical carcinoma. Ann Oncol 2003;14:1285-1290.
  15. Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 2001; 358:781-786.
  16. Choi CH, Lee YY, Kim MK, Kim TJ, Lee JW, Nam HR, et al. A matched-case comparison to explore the role of consolidation chemotherapy after concurrent chemoradiation in cervical cancer. Int J Radiat Oncol Biol Phys 2011; 81:1252-1257.
  17. DiSilvestro PA, Ali S, Craighead PS, Lucci JA, Lee YC, Cohn DE, et al. Phase III randomized trial of weekly cisplatin and irradiation versus cisplatin and tirapazamine and irradiation in stages IB2, IIA, IIB, IIIB, and IVA cervical carcinoma limited to the pelvis: a GynecologicOncology Group study. J Clin Oncol 2014;32:458-464.
  18. Duenas-Gonzalez A, Zarba JJ, Patel F, et al. Phase III, openlabel, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol 2011;29:1678-1685.
  19. Cetina L, Garcia-Arias A, Candelaria M, Cantu D, Rivera L, Coronel J, et al. Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients. World Journal of Surgical Oncology. 2009 Dec;7(1):19.
  20. Huguet F, Cojocariu OM, Levy P, Lefranc JP, Darai E, Jannet D, et al. Preoperative concurrent radiation therapy and chemotherapy for bulky stage IB2, IIA, and IIB carcinoma of the uterine cervix with proximal parametrial invasion. International Journal of Radiation Oncology Biology Physics. 2008 Dec 1;72(5):1508-1515.
  21. LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1049-1091
  22. Morice P, Uzan C, Zafrani Y, Delpech Y, Gouy S, Haie-Meder C. The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer. Gynecologic oncology. 2007 Oct 1;107(1):S122-S124.
  23. Park DC, Kim JH, Lew YO, Kim DH, Namkoong SE. Phase II trial of neoadjuvant paclitaxel and cisplatin in uterine cervical cancer. Gynecologic Oncology 2004 Jan 1;92(1):59-63.
  24. Modarress M, Maghami FQ, Golnavaz M, Behtash N, Mousavi A, Khalili GR. Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB.IIB bulky cervical cancer and with tumor diameter greater than 4 cm. International Journal of Gynecological Cancer. 2005 May;15(3):483-488.
  25. Gupta S, Maheshwari A, Parab P, Mahantshetty U, Hawaldar R, Sastri S, et al. Neoadjuvant chemotherapy followed by radical surgery versus concomitant chemotherapy and radiotherapy in patients with stage IB2, IIA, or IIB squamous cervical cancer: a randomized controlled trial. Journal of Clinical Oncology. 2018 Feb 12;36(16):1548-1555.
  26. Derks M, van Lonkhuijzen LR, Bakker RM, Stiggelbout AM, de Kroon CD, Westerveld H, et al. Long-term morbidity and quality of life in cervical cancer survivors: a multicenter comparison between surgery and radiotherapy as primary treatment. International Journal of Gynecological Cancer. 2017 Feb 1;27(2):350-356.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.