Efficacy and Toxicity of Concurrent Chemoradiotherapy without brachytherapy in Locally Advanced Cervical Cancer: a Phase II Clinical Trial

Concurrent chemoradiotherapy (EBRT + cisplatin) plus intracavitary brachytherapy is the standard of care in patients with advanced cervical cancer. However, some patients are unable to undergo brachytherapy due to massive residual tumor or anatomical distortion. In this study, we evaluated the treatment outcome in patients with locally advanced cervical cancer undergoing conventional EBRT plus cisplatin based chemotherapy. in this prospective phase 2 trial, we selected patients with locally advanced cervical carcinoma (stage: IIB to IIIB) undergoing external beam radiotherapy and chemotherapy without brachytherapy at our institute between Oct. 2007 and Oct. 2009. The patients received 50 Gy in 5 weeks to whole pelvic followed by a localized boost dose on tumor to 70 Gy concurrently with cisplatin 35 mg/m2 weekly. The treatment related toxicities and survival (overall and disease free) were evaluated. 30 cases with a median age of 55 (range; 40 to 73) were studied. According to FIGO classification, the Clinical stages were as follows: stage: IIB 23, IIIA 4, and IIIB 3 cases. Three months after treatment, 19 patients (63.3%) achieved complete response. With a median follow up time of 18 months (range; 10-33 months), 8/23 cases (34.7%) with stage IIB and 2/7 (28.5%) among stage IIIA-IIIB remained disease free at the end of follow up. Data showed a 2-year overall survival rate of 58.7% ± 9% and 2- year disease free survival of 37.7% ± 9%. Most toxicities were grade I and II. 2 (6.6%) grade III diarrhea and 4 (13.3%) grade III neutropenia were recorded. Although a considerable number of patients achieved complete response using concurrent chemoradiotherapy without brachytherapy, the overall treatment outcomes especially for stage IIIA-IIIB were unsatisfactory. Using modern radiation therapy techniques with increased delivered boost dose might improve treatment results.