A randomized trial of chemotherapy followed by pelvic radiation therapy in stage IIIB carcinoma of the cervix.

Abstract

Because of the poor results in stage III B carcinoma of the cervix with standard treatment using radiotherapy alone, we designed a randomized trial to determine whether administration of chemotherapy before pelvic irradiation would improve survival. Between May 1984 and August 1986, 107 patients with previously untreated squamous cell carcinoma were randomly assigned, after stratification by age (less than 50 v greater than 50 years), extent of parametrial involvement (unilateral v bilateral), and lymphangiographic findings (negative v positive) to pelvic radiotherapy (RT; arm A) or three cycles of chemotherapy (CT; bleomycin, vincristine, mitomycin, and cisplatin [BOMP]), followed by the same radiotherapy regimen (CT + RT; arm B). The groups were balanced by age, performance status, extent of parametrial involvement, bulkiness of cervical disease, nodal involvement, and presence of hydronephrosis. Minimal follow-up is 34 months. A complete local response was observed in 32.5% of the patients in arm A and in 47% of the patients in arm B (P = .19). Overall 5-year survival rates were 39% for the RT arm and 23% for the CT + RT approach (P = .02). Toxicity was severe in arm B and included fatal pulmonary toxicity in four patients. Locoregional and distant failures were similar in both groups. We conclude that, despite a satisfactory response rate, neoadjuvant BOMP chemotherapy adversely affects survival in stage III B cervical cancer and is associated with unacceptable toxicity.

Radiotherapy Combined with Transcatheter Arterial Infusion Chemotherapy for Locally Advanced Cervical Cancer

“…Thus several investigations have been undertaken in the treatment of this tumor. A randomized trial comparing radiation therapy with or without the use of neoadjuvant chemotherapy noted a failure to improve the survival outcome (12), reportedly due to the deaths from bleomycin pulmonary toxicity (13). In other studies of concurrent uses of radiation therapy and systemic chemotherapy using CDDP or other chemotherapeutic agents (14)(15)(16)(17), high local control rates were reported.…”

Neoadjuvant hormonal therapy prior to radical prostatectomy: promises and pitfalls

“…Indeed, it remains possible that delay in de®nitive local therapy by neoadjuvant treatments may be detrimental. Lack of bene®t of neoadjuvant chemotherapy in other solid tumors, such as cervix, 53 small cell lung 54 and bladder, 55 illustrates that use of therapies capable of inducing complete responses may not have positive effects on survival when use in a neoadjuvant setting. Determining whether 3 months of NHT reduces recurrences after radical prostatectomy will have to await maturation of the recently completed Phase III studies 30 ± 36 (Table 2).…”

Clinical Efficacy and Prognostic Factors in Locally Advanced Cervical Cancer Patients Treated With Concurrent Chemoradiotherapy

“…However, there was few detailed analysis and report about the late complications caused by the concurrent chemoradiotherapy. Eifel and his colleagues [7] reported the similar late toxicities after 6.6 years' median follow-up visit after the concurrent chemoradiotherapy and extended field radiotherapy, which were 13 % and 12 %, respectively. Pearcey and his colleagues [8] reported the similar incidence of late toxicities in the patients weekly operated for cisplatin concurrent chemoradiotherapy.…”