Concurrent definitive chemoradiation incorporating intensity-modulated radiotherapy followed by adjuvant chemotherapy in high risk locally advanced cervical squamous cancer: a phase II study

• Published in: BMC cancer 2022-12, Vol.22 (1), p.1331-1331, Article 1331
• Main Authors: Zhang, Gong-Yi, Zhang, Rong, Bai, Ping, Li, Shu-Min, Zhang, Yuan-Yuan, Chen, Yi-Ran, Huang, Man-Ni, Wu, Ling-Ying
• Format: Article
• Language: English
• Subjects: Adjuvant chemotherapy; Adjuvant treatment; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Breast Neoplasms - pathology; Cancer; Carcinoma, Squamous Cell - pathology; Care and treatment; Cervical cancer; Chemoradiotherapy - adverse effects; Chemotherapy, Adjuvant - adverse effects; Cisplatin; Female; Humans; IMRT; Intensity-modulated radiotherapy; Leukopenia - chemically induced; Metastasis; Neoplasm Staging; Paclitaxel - therapeutic use; Patient outcomes; Prospective Studies; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Squamous cell carcinoma; Uterine Cervical Neoplasms - pathology
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-022-10406-9

Although the prognosis of locally advanced cervical cancer has improved dramatically, survival for those with stage IIIB-IVA disease or lymph nodes metastasis remains poor. It is believed that the incorporation of intensity-modulated radiotherapy into the treatment of cervical cancer might yield an improved loco-regional control, whereas more cycles of more potent chemotherapy after the completion of concurrent chemotherapy was associated with a diminished distant metastasis. We therefore initiated a non-randomized prospective phaseII study to evaluate the feasibility of incorporating both these two treatment modality into the treatment of high risk locally advanced cervical cancer. To determine whether the incorporation of intensity-modulated radiotherapy and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment policy for patients with high risk locally advanced cervical cancer might improve their oncologic outcomes. Patients were enrolled if they had biopsy proven stage IIIA-IVA squamous cervical cancer or stage IIB disease with metastatic regional nodes. Intensity-modulated radiotherapy was delivered with dynamic multi-leaf collimators using 6MV photon beams. Prescription for PTV ranged from 45.0 ~ 50.0 Gy at 1.8 Gy ~ 2.0 Gy/fraction in 25 fractions. Enlarged nodes were contoured separately and PTV-nodes were boosted simultaneously to a total dose of 50.0-65 Gy at 2.0- 2.6 Gy/fraction in 25 fractions. A total dose of 28 ~ 35 Gy high-dose- rate brachytherapy was prescribed to point A in 4 ~ 5 weekly fractions using an iridium- 192 source. Concurrent weekly intravenous cisplatin at 30 mg/m was initiated on the first day of radiotherapy for over 1-h during external-beam radiotherapy. Adjuvant chemotherapy was scheduled within 4 weeks after the completion of concurrent chemo-radiotherapy and repeated 3 weeks later. Paclitaxel 150 mg/m was given as a 3-h infusion on day1, followed by cisplatin 35 mg/m with 1-h infusion on day1-2 (70 mg/m in total). Fifty patients achieved complete response 4 weeks after the completion of the treatment protocol, whereas 2 patients had persistent disease. After a median follow-up period of 66 months, loco-regional (including 2 persistent disease), distant, and synchronous treatment failure occurred in 4,5, and 1, respectively. The 5-year disease-free survival, loco-regional recurrence-free survival, distant-metastasis recurrence-free survival was 80.5%, 90.3%, and 88.0%, respectively. Four of the patie